Fillable Form DS-3053 (2018)

What is Form DS-3053?

Form DS-3053, Statement of Consent: Issuance of a U.S. Passport to a Minor Under Age 16, is used by the parent or guardian of a minor to give consent for the issuance of the minor’s passport. This form should be completed if one parent or legal guardian cannot accompany the minor at the time of application.

What is required to apply for a passport?

You may apply for a passport if you have the following documents:

• Form DS-11, Application for a U.S. Passport

Form DS-11 is used when applying for their first passport. It is used by U.S. citizens and U.S. nationals. This form can also be used by individuals who misplaced their passports, people who changed their names, or have not had a passport for over 15 years.

• Proof of U.S. citizenship

Birth or naturalization certificate.

• Government-issued photo ID

A photo ID issued by the government such as a driver’s license or a military ID.

• Color passport photo

A 2x2” colored passport photo.

• Fee payment

Your payment for the applicable fees.

What is the purpose of Form DS-3053?

Form DS-3053 is used when only one of the parents or legal guardians can accompany the minor at the time of application for a passport. The statement of consent must be given by the accompanying guardian. If the required consent is not submitted, the minor may not be able to acquire a passport.

WHEN FILLING OUT FORM DS-3053, THESE INSTRUCTIONS MUST BE FOLLOWED:

• This form requires you to fill out fields 1, 2, and 3. If you do not complete field 3. The authorization will be valid for all products.
• If you are the non-applying parent or guardian, you must complete field 4 stating your consent to the issuance of a passport to your minor.
• The application for a new passport that is accompanying the written consent of the non-applying parent must not be more than 90 days old. Acquire a front and back photocopy of your government-issued ID and present it to a notary along with the written consent.
• Submit this form along with your minor’s Form DS-11 passport application to any designated facility, U.S. passport agency, U.S. embassy, or U.S consulate board.

THESE ARE THE SPECIAL REQUIREMENTS FOR INSTITUTIONS/ENTITIES GRANTED GUARDIANSHIP

These are the required documents that you must submit with the DS-3053:

• A grant of guardianship to the institution or entity that is certified by a court of competent jurisdiction. A photocopy of said certificate is not acceptable.
• A statement that is signed by the institution/entity on letterhead, that is authorizing a specific person, to apply for a passport on behalf of the minor. The statement must contain the name of the minor and the parent/guardian applying on his or her behalf.
• Provide a photocopy of employee identification documents that prove that the person applying for a passport on the minor’s behalf works at the institution or entity.

Make sure that the documents above do NOT have any conditions on the validity period of the passport or where the minor is allowed to travel. If there are specified conditions on the statements, a new statement of clear consent is required.

A warning is stated on this form that you should not enter any false information as it may lead to punishments and imprisonment under U.S. law.

FOR INFORMATION AND QUESTIONS

There are specific websites and contact numbers provided on the form should you have any questions or clarifications regarding passports or travel information.

You may visit the official website of the U.S. Department of State.

Contact the National Passport Information Center at 1-877-487-2778 or you may email them at NPIC@state.gov.

If you want information regarding International Parental Child Abduction, visit travel.state.gov/child abduction or contact the Office of Children’s Issues on their telephone number 1-888-407-4747 or email them at PreventAbduction1@state.gov.

WHEN YOU ARE FILLING OUT FORM DS-3053, YOU ARE UNDER THE PROVISIONS OF THE FOLLOWING LAWS

PRIVACY ACT STATEMENT

The privacy act is presented on this form to ensure that all the information and documents that you have provided will be used for legal purposes only.

The Department of State is authorized to collect this information.

The purpose of gathering the information provided is to establish two parent/guardian consent for a minor’s passport application.

The information may be shared with other domestic government agencies or any other authorized offices that may need to use this information for important purposes.

If you fail to provide the necessary information requested on the form may result in refusal or denial of the U.S. passport application.

PAPERWORK REDUCTION ACT STATEMENT

The estimated time of response for the public reporting burden of collecting the information collected is about 20 minutes. That includes all the necessary steps in reviewing the form and the provided documents for the application.

How to fill out Form DS-3053?

• MINOR’S NAME

Enter the name of the minor you are applying a passport for using the following format: Last, First, Middle.

• MINOR’S DATE OF BIRTH

Enter the date of birth of your minor using the following format: Month-Date-Year

• VALIDITY OF THE AUTHORIZATION

You may choose from the following options:

• Passport Book and Card
• Book Only
• Card Only

• STATEMENT OF CONSENT

This section is to be filled out by the non-applying parent or guardian when he/she is not present at the time when the applying parent submits the minor’s application.

Print Name

Enter your name.

Printed Name of applying parent/guardian

Enter the name of the parent/guardian you are authorizing to apply on behalf of the minor.

Street Address

Enter your street address.

Apartment

Enter the name of your apartment if applicable.

City

Enter the city where your address is located.

State

Enter the state.

ZIP Code

Enter the zip code.

Area Code and Telephone Number

Enter the area code first, then your telephone number.

Email Address

Enter your email address if it is available.

This section must be completed in front of a notary

OATH

By signing this form, you are declaring that all the information you have entered on this form is true and correct.

Signature of non-applying parent/guardian

Enter your signature.

Date

Enter the date when this form is signed using the following format: Month-Day-Year.

NOTE
A front and back photocopy of the identification you presented the notary must be presented on this form.

• STATEMENT OF CONSENT NOTARIZATION

This part is to be filled out by the notary.

Name of Notary

Enter your name.

Location

Enter the location of your office.

Commission Expiration

Enter the date when your commission expires using the following format: Month-Day-Year.

Notary Seal

Provide the seal.

Identification Presented by Non-Applying parent/guardian

You may choose from the options provided regarding the identification that is presented to you. You may choose: Driver’s License, Passport, Military ID, or if the identification provided is not among the choices, indicate what type of identification the non-applying parent/guardian has provided.

ID Number

Enter the number of the identification provided.

Place of issue

Enter the place where the identification was issued.

Issue Date

Enter the date when the identification was issued using the following format: Month-Day-Year.

Expiration Date

Enter the date when the identification will expire using the following format: Month-Day-Year.

OATH

By signing the document, you are certifying that you are a licensed notary and that you are not related to the affiant, and you have personally witnessed him/her sign the document. The oath also states that you have verified the identity of the non-applying parent/guardian.

Signature of notary

Enter your signature.

Date of Notarization

Enter the date when the document is notarized using the following format: Month-Day-Year.