STATEMENT

Date: ______________

U.S. Department of State

Passport Office

Washington, DC

To Whom It May Concern:

I, ____________________________, am the bearer of valid U.S. Passport number ________________________ issued on _____________________.

In view of the time delay in obtaining visas or travel restrictions, it is impossible to complete my trip using one passport, therefore, I am requesting for an issuance of a second passport (valid for 2 years only).

Should either passport be lost or stolen, I will report immediately the circumstances of the loss to Passport Services, or if abroad, to the nearest U.S. embassy or consulate.

Thank you for your consideration.

Applicant’s Signature: ___________________________________

(Please sign in Blue Ink)