DS-64 Statement Regarding a Lost or Stolen Passport Book and/o

Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card

Form DS-64_OMB No 1405-0014

Statement Regarding a Lost or Stolen U.S. Passport Book and/or Card

OMB: 1405-0014

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U.S. Department of State

STATEMENT REGARDING A VALID LOST OR STOLEN U.S. PASSPORT BOOK AND/OR CARD

OMB Control No. 1405-0014
Expiration Date: XX-XX-XXXX
Estimated Burden: 5 Minutes

If your most recent lost or stolen passport is expired, it is no longer valid and you do not need to submit this form.

HOW TO REPORT A VALID LOST OR STOLEN PASSPORT BOOK AND/OR CARD
To report a valid lost or stolen passport, please choose ONE of the following options:
1.

ONLINE: Visit our website at travel.state.gov.
OR

2.

WHILE APPLYING FOR A NEW U.S. PASSPORT: Submit this form with a new DS-11, Application for U.S. Passport along with
required documentation, to any designated acceptance facility, U.S. passport agency, U.S. embassy, or U.S. consulate abroad.
OR

3.

BY PHONE: Call 1-877-487-2778 (TDD: 1-888-874-7793) and follow the representative's instructions. This option is not
available for customers abroad.
OR

4.

BY MAIL: Submit this form AND a front and back photocopy of a government-issued photo identification (such as a driver's
license or state-issued identification) to the following address* ONLY IF you are NOT applying for a new U.S. passport book
and/or card:

AF
T

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

* Only use this address to submit this form or other correspondence about lost/stolen passports. For general inquiries, call the National Passport Information Center at 1-877-487-2778.

Protect yourself against identity theft! Report a lost or stolen U.S. passport!
For more information, please visit our website: travel.state.gov

WARNING

R

False statements made knowingly and willfully on this form, in U.S. passport applications, or in affidavits or other supporting
documents submitted therewith are punishable by fine and/or imprisonment under U.S. law, including the provisions of 18 U.S.C.
1001 and/or 18 U.S.C. 1542. Alteration or mutilation of a U.S. passport is punishable by fine and/or imprisonment under the
provisions of 18 U.S.C. 1543. The use of a U.S. passport in violation of the restrictions contained therein or of the passport
regulations is punishable by fine and/or imprisonment under 18 U.S.C. 1544. All statements and documents submitted are subject to
verification.

PRIVACY ACT STATEMENT

D

AUTHORITIES: We are authorized to collect this information by 22 U.S.C. 211a et seq.; 8 U.S.C. 1104; 8 U.S.C. 1737; Executive
Order 11295 (August 5, 1966); and 22 C.F.R. Parts 50 and 51.
PURPOSE: The information requested on this form is used to ensure that no one has more than one valid U.S. passport book
and one valid U.S. passport card at any one time, except as authorized by the U.S. Department of State, and to combat passport
fraud and misuse. The collection of the Social Security number will be used to verify the identity of the person reporting the lost
or stolen passport and to identify the passport being reported lost or stolen. There is no other purpose unless authorized by law.
ROUTINE USES: This information may be disclosed to another domestic government agency, a private contractor, a foreign government
agency, or to a private person or private employer in accordance with certain approved routine uses. These routine uses include, but are
not limited to, law enforcement activities, employment verification, fraud prevention, border security, counterterrorism, litigation activities,
and activities that meet the Secretary of State's responsibility to protect U.S. citizens and non-citizen nationals abroad. For a more detailed
listing of the routine uses to which this information may be put, please see the Department of State's Prefatory Statement of Routine Uses
(Public Notice 6290 of July 15, 2008) and the listing of routine uses set forth in the System of Records Notices for Overseas Citizen
Services Records and Other Overseas Records (State-05) and Passport Records (State-26).
DISCLOSURE: Providing your Social Security number and other information on this form is voluntary, but failure to provide the
information on this form may, given the form's purpose of verification of your identity, result in processing delays.

PAPERWORK REDUCTION ACT STATEMENT
Public reporting burden for this collection of information is estimated to average five minutes per response, including time required
for searching existing data sources, gathering the necessary data, providing the information and/or documents required, and
reviewing the final collection. You do not have to supply this information unless this collection displays a currently valid OMB control
number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send them
to: Passport Forms Officer, U.S. Department of State, Bureau of Consular Affairs, Passport Services, Office of Program Management
and Operational Support, 44132 Mercure Cir., P.O. Box 1199, Sterling, VA 20166-1199.

DS-64 xx-xxxx

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U.S. Department of State

STATEMENT REGARDING A VALID LOST OR STOLEN U.S. PASSPORT BOOK AND/OR CARD

OMB Control No. 1405-0014
Expiration Date: XX-XX-XXXX
Estimated Burden: 5 Minutes

Please Print Legibly Using Black Ink Only.

IMPORTANT NOTICE
A U.S. national may not normally bear more than one valid or potentially valid U.S. passport book and/or card at a time. Therefore, a statement is
required when applying for a new U.S. passport if the previously valid or potentially valid passport is not submitted. Your statement must detail why
the previous valid U.S. passport cannot be presented. The information you provide on this form will be placed into the Consular Lost and Stolen
Passport System, which is designed to prevent the misuse of all reported valid lost or stolen U.S. passports. If more than one valid U.S. passport
previously issued to you was lost or stolen, your replacement passport may be limited in validity. ONCE REPORTED, THE VALID LOST OR STOLEN
PASSPORT IS ELECTRONICALLY CANCELLED AND CANNOT BE USED FOR TRAVEL. Anyone (including the bearer) traveling on a reported
lost or stolen passport may be detained upon entering the United States. Should you locate the passport after reporting it lost or stolen, submit it for
cancellation to the Consular Lost and Stolen Passport Unit (CLASP). See page one of this form for contact information.

Please select the document (or documents) that you are reporting and its status.
Valid U.S. Passport Card
Lost
Stolen
Lost

Valid U.S. Passport Book

Are you submitting this form in connection with an application for a new U.S. passport book and/or card?
1.

Stolen
Yes

No

IDENTIFYING INFORMATION OF PASSPORT HOLDER Type or print legibly in black ink in white areas only.

Last Name

First Name

Middle Name

Has your name changed since the passport was issued? If yes, state the name in which the lost or stolen valid passport was issued.

Date of Birth (mm-dd-yyyy)

Place of Birth (City & State if in U.S. or City & Country)

Social Security Number

AF
T

Current Address (Street, City, State, and ZIP Code or Country, if outside the U.S.
Telephone Number

Alternative Telephone Number

Email Address

Answer all questions completely. If you do not
know the answer in detail, be as exact as possible.
The passport book and card have different numbers. Please provide the correct number(s) if known. The passport number on a lost or stolen passport cannot be reused.

2.

VALID LOST OR STOLEN U.S. PASSPORT BOOK/CARD INFORMATION

Explain in detail how your valid U.S. passport book/card was lost or stolen. Include a photocopy of the valid passport book/card if available.

Explain where the loss or theft occurred. Provide the address, if known (City and State, if in the U.S., or City and Country as it is presently known)

R

On what date was your valid U.S. passport book/card lost or stolen (mm-dd-yyyy)? If unknown, when was the last time you remember it being in your possession?
Did you file a police report? (If yes and the report is available, please submit a copy.)

D

List your valid lost or stolen U.S. Passport Book, if known:
Number

Issue Date
(mm-dd-yyyy)

Have you had any other valid U.S. passport book/card lost or stolen?
If yes, how many passports?

Yes

No

List your valid lost or stolen U.S. Passport Card, if known:
Number

Yes

Issue Date
(mm-dd-yyyy)

No

Approximate date(s)?
(mm-dd-yyyy)

Did you file a police report?

Yes

No

(If yes and the report is available, please submit a copy.)

3. YOU MUST SIGN AND DATE THE APPLICATION IN THE DESIGNATED AREA BELOW
I, the undersigned, declare under penalty of perjury all of the following: 1) that I have read and understood the warning on page one of this form; 2)
the information provided herein is correct and complete; 3) I have not given my U.S. passport book and/or passport card to another person or disposed
of it in an unauthorized manner; 4) I understand that the U.S. passport(s) I report as missing will be invalidated and cannot be used; and 5) if I
subsequently find and recover it, I will immediately return the passport and/or passport card to Passport Services at the address on page one of this
form or to the nearest U.S. passport agency, U.S. embassy or U.S. consulate, if abroad, and I will not attempt to use it.
Applicant's Legal Signature - age 16 or older

Date (mm/dd/yyyy)

Mother/Father/Parent/Guardian Legal Signature if identifying minor under age 16

Date (mm/dd/yyyy)

Mother/Father/Parent/Guardian Legal Signature if identifying minor under age 16

Date (mm/dd/yyyy)

Both parents or guardians of a child younger than 16 years old must sign and provide a front and back photocopy of ID when submitting this form on the child's behalf unless one
parent or guardian has sole authority to obtain a passport pursuant to 22 C.F.R. 51.28. If there is sole authority, include a copy of a supporting document with this form, such as a court order
proving sole legal custody or form DS-5525, Statement of Exigent/Special Family Circumstances for Issuance of a U.S. Passport to a Minor Under Age 16.

DS-64 xx-xxxx

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File Typeapplication/pdf
File Modified2021-08-18
File Created2021-02-18

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