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APPLICATION FOR ADDITIONAL VISA PAGES

OR MISCELLANEOUS PASSPORT SERVICES

PLEASE DETACH AND RETAIN THIS INSTRUCTION SHEET FOR YOUR RECORDS

Date of Application:__________________________

INFORMATION, QUESTIONS, AND INQUIRIES

Please visit our website at travel.state.gov. In addition, you may contact the National Passport Information

Center (NPIC) toll-free at 1-877-487-2778 (TDD:1-888-874-7793) or by email at NPIC@state.gov. Customer

Service Representatives are available Monday-Friday 8:00a.m.-10:00p.m. Eastern Time (excluding federal

holidays). Automated Information is available 24 hours a day, 7 days a week.

HOW DO I APPLY FOR ADDITIONAL VISA PAGES?

1. Complete, sign, and date this form.

2. Send this form with your valid U.S. passport book and your fee for additional visa pages. Please visit our website at travel.state.gov for detailed

information regarding current fees.

THE CURRENT PASSPORT FEE. Enclose the fee in the form of a personal check or money order. MAKE CHECKS PAYABLE TO "U.S. DEPARTMENT OF

STATE." THE FULL NAME AND DATE OF BIRTH OF THE APPLICANT MUST BE TYPED OR PRINTED ON THE FRONT OF THE CHECK. DO NOT

SEND CASH. Passport Services cannot be responsible for cash sent through the mail. By law, the fees are non-refundable.

NOTE: Because of the sensitivity of the enclosed documents, Passport Services recommends using trackable mailing service when submitting your application.

MAIL FORM TO:

FOR ROUTINE SERVICE:

FOR EXPEDITED SERVICE (Additional Fee):

National Passport Processing Center

Post Office Box 90106

Post Office Box 90906

Philadelphia, PA 19190-0106

Philadelphia, PA 19190-0906

OVERNIGHT DELIVERY SERVICE: If you desire overnight delivery for the return of your passport, please include the appropriate fee with your application.

FASTER PROCESSING: For an additional fee, you may request expedited service. Please include this fee with your application, and mail to the appropriate

address. Please write "Expedite" ON OUTER ENVELOPE WHEN MAILING. TO ENSURE MINIMAL PROCESSING TIME for expedited applications,

Passport Services recommends using overnight delivery when submitting the application AND including the appropriate postage fee for return

overnight delivery for the completed passport book. Expedited service is available only in the United States. Please consult our website for updated fee

information and processing times.

HOW WILL MY PASSPORT BOOK BE MAILED BACK TO ME?

 Your U.S. passport book will be returned to you by priority mail. To check the status of your passport application online please visit travel.state.gov.

NOTE REGARDING MAILING ADDRESSES: Passport Services will not mail a passport to a private address outside the United States. If you do not live at the

address listed in the "mailing address", then you must put the name of the person and mark it as "In Care Of." If your mailing address changes prior to receipt of

your new passport, please contact the National Passport Information Center at 1-877-487-2778 or visit travel.state.gov.

FAILURE TO PROVIDE INFORMATION REQUESTED ON THIS FORM, INCLUDING YOUR SOCIAL SECURITY NUMBER,

MAY RESULT IN SIGNIFICANT PROCESSING DELAYS AND/OR THE DENIAL OF YOUR APPLICATION.

NOTICE TO APPLICANTS RESIDING ABROAD

United States citizens residing abroad CANNOT submit the form to the domestic addresses listed above. Such applicants should contact the nearest U.S.

Embassy or Consulate for procedures to be followed when applying overseas.

WARNING: False statements made knowingly and willfully in passport applications, including affidavits or other documents submitted to support

this application, are punishable by fine and/or imprisonment under U.S. law including the provisions of 18 U.S.C. 1001, 18 U.S.C. 1542, and/or 18

U.S.C. 1621. Alteration or mutilation of a passport issued pursuant to this application is punishable by fine and/or imprisonment under the

provisions of 18 U.S.C. 1543. The use of a 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 are subject to verification.

If you choose to provide your email address in Item #6 on this application, Passport Services may use that information to contact you in the event there is a

problem with your application or if you need to provide information to us.

DS-4085 08-2013

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