The Nigeria Immigration Service https://portal.immigration.gov.ng/passport/summary/chk/1/p/n/id/1E1E1...

Standard ePassport Application Form

Important Information

Application Id: 12071577

Reference No: 1437153950

General Information
Title

Last name (Surname)

First name

Middle name

Gender

Date of birth (dd-mm-yyyy)

Passport Booklet Type

Place of birth

Permanent Address (in Nigeria)

Address 1

Address 2

City

Country

State

LGA

District

Postcode

Contact Information

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The Nigeria Immigration Service https://portal.immigration.gov.ng/passport/summary/chk/1/p/n/id/1E1E1...

State of Origin

Nationality

Home town

Contact phone

Email

Mobile phone

Occupation

Maiden name

Personal Features
Marital status

Color of eyes

Color of hair

Height (in cm)

Other Information
Special Features

Next of kin name

Relationship with next of kin

Contact number of next of kin

Kin Address
Address 1

Address 2

City

Country

State

LGA

District

Postcode

Passport Processing Country, State and Office

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The Nigeria Immigration Service https://portal.immigration.gov.ng/passport/summary/chk/1/p/n/id/1E1E1...

Processing State

Passport Office

Submission
Any false declaration on this form may lead to the withdrawal of the passport and/or prosecution of the applicant.

Date: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Signature / Thumb Impression: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

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