Form DS-64 PDF Template

What is a Form DS-64?

Form DS-64 is issued by the U.S. Department of State for reporting a lost or stolen U.S. passport book or card. This form is essential for ensuring that the missing passport is invalidated, preventing its misuse. Completing Form DS-64 initiates the process to report the passport's loss or theft, which is crucial for protecting your identity and securing the issuance of a new passport. The form can be submitted online, by mail, or by phone, and is often submitted alongside Form DS-11 when applying for a new passport.

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How to Fill in Our Form DS-64 PDF Template

Follow these steps to fill in the Form DS-64 template:

Header Information: Include the OMB Control Number (1405-0014) and the Expiration Date.
Options to Report Loss/Theft:

Online: Visit travel.state.gov.
Phone: Call 1-877-487-2778 (TDD: 1-888-874-7793). Not available for customers abroad.
Mail: Submit the form and a photocopy of a government-issued photo ID to:

ATTN: CLASP, U.S. Department of State, CA/PPT/S/CLASP, 44132 Mercure Cir, P.O. Box 1227, Sterling, VA 20166-1227.

Important Notices:

False statements are punishable by law.
Providing accurate and truthful information is essential.

Privacy Act Statement:

Authorities and purposes for data collection.
Disclosure of Social Security number and other personal information is voluntary but may result in processing delays if not provided.
Routine uses of the information include law enforcement and fraud prevention.

Filling in Personal Information:

Personal Details: Last name, first name, middle name, date of birth, place of birth, Social Security number, current address, telephone number, and email address.
Passport Details: Select the type of document (passport book or card) and its status (lost or stolen).
Application Connection: Indicate if the form is submitted in connection with a new passport application.
Name Change: If applicable, state the previous name under which the lost or stolen passport was issued.

Incident Details:

Explanation: Describe how the passport was lost or stolen.
Location: Provide the address where the loss or theft occurred.
Date: Specify the date when the passport was lost or stolen or the last known date it was in your possession.
Police Report: Indicate if a police report was filed and attach a copy if available.

Additional Passports: List any other valid U.S. passports that have been lost or stolen, including approximate dates and numbers if known.
Signatures:

Applicant's Signature: Sign and date the form.
Parent/Guardian Signatures: If the applicant is under 16, both parents or guardians must sign and provide ID photocopies. If only one parent has sole authority, include supporting documentation.

Final Steps:

Print legibly or type in black ink.
Submit the completed form to the appropriate address or as instructed online or by phone.