I declare that I am a citizen of Vanuatu and no other country (Tick one of the options as applicable)

Born after 30 July 1980, with at least one parent that was a Vanuatu citizen at the time of birth (Provide Either original birth certification showing at least one parent of indigenous ni-Vanuatu ancestry, OR original birth certificate showing at least one parent who is a Vanuatu citizen, and proof of the Parent's citizenship e.g Citizenship Certificate)

Born on or before 30 July 1980 and of indigenous ni-Vanuatu ancestry. (Provide an original birth certificate showing at least one ni-Vanuatu parent).

Citizen by naturalization granted by the Citizenship Commission after 30 July 1980. (Provide both an original birth certificate and Vanuatu citizenship Certificate) List previous nationality/ies and passport details below.

Previous Nationality/ies

Passport No

Place of Issue

Issue Date

Expiry Date

(Parent or Guardian to complete this section and sign the Application Declaration below)

I consent to a passport being issued to

My relationship to the child is Mother Father Guardian

My name is

My Date of Birth ...

Full Name

Address

Phone no

Passport No

I declare that all particulars in this application are true in all respects. I understand that if I make a false or misleading statement, orally or in writing, in connection with this Vanuatu passport application I can, by law, be fined up to VT 5,000,000 and imprisoned for up to 5 years or both.

Date

Signature

I declare that I have known the applicant for at least one year, and the information on this form is correct to the best of my knowledge. The person in the passport photo is the applicant named on this form.

Signature/Thumbprint of Witness