Form DS-3053 PDF Template

What is a Form DS-3053?

Form DS-3053, also known as the "Statement of Consent: Issuance of a U.S. Passport to a Child," is a document used by the U.S. Department of State when one or both legal parents or guardians cannot apply in person with their child for a passport. This form allows the absent parent or guardian to provide notarized consent for the child's passport application. It is particularly essential for ensuring that both parents agree to the issuance of a passport, which helps prevent international child abduction. The form must be notarized and is valid for 90 days after notarization. Failure to provide the required consent can result in the denial of the child's passport application.

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How to Fill in Our Form DS-3053 PDF Template

Follow these steps to fill in the Form DS-3053 template:

Child’s Name: Enter the child’s last, first, and middle names as they appear on the DS-11 application.
Child’s Date of Birth: Provide the child’s birth date in the format mm/dd/yyyy.
Consent Validity: Indicate whether the consent is for a passport book and card, book only, or card only.
Is Child Under 16?:

If yes, print the name of the adult applying with the child.
If no, skip to the next section.

Statement of Consent: The parent or guardian who cannot apply in person must:

Print their name.
Provide their street address, apartment number (if applicable), city, state, and ZIP code.
Enter their telephone number with area code and email address.
Sign and date the form in front of a notary.

For Completion by Notary:

The notary will verify the identity of the parent or guardian by checking their identification documents.
The notary will print their name, the location (city and state), and their commission expiration date.
The notary will affix their seal and provide the date of notarization.
The parent or guardian’s identification details (type, number, place of issue, issue date, and expiration date) must be recorded.

Additional Requirements:

Submit a photocopy of the front and back of the identification presented to the notary.
Ensure that the date of the notary’s signature matches the date of the parent's or guardian's signature.