APPLICATION FOR A GRENADIAN PASSPORT

Please read the following instructions carefully before completing the form.
HOW TO COMPLETE THE FORM (D) If the person has changed his or her name, the registered birth certificate or
• All relevant sections must be completed by all applicants. deed poll recording the change must also be submitted.
• Answers should be clearly written in the applicant's own handwriting or
parent's/guardians in the case of persons under 16 years of age, using pen (E) All documents submitted such as birth, marriage, divorce, registration
and block capitals. certificates and deed poll must be in its original form with a photo copy.

SIGNING THE FORM (F) Photographs. Two copies of a recent photograph (not more than six months)
The Passport Holder must sign the form in the space provided above section of the applicant or of a child under the age of sixteen (16) must be included with
1 and in section 11. For children under 16 yrs. the parent(s) or Guardian(s) must the application. These portraits must be taken full face without hat or head bands,
sign section 11 only. Section 12 should be completed by the person verifying the the portrait shall show the applicant looking directly at the camera. It should have
declaration who should be a member of Parliament, Justice of the Peace, appropriate brightness and contrast if in colour, it should show skin tones
Minister of Religion, Medical or Legal Practitioner, Established Civil Servant, naturally. The size of the photographs shall not be longer than 45x35mm
Principal and other qualified Teachers, Bank Official, Police Officers from the (1.77x1.38in) nor smaller than 32x26mm (1.26x1.02in) in height and width. The
rank of Inspector or any person of similar standing personally acquainted with portraits must be printed on normal thin photographic paper and must not be
the applicant.
glazed on the reverse side. The recommender is also required to endorse the
A member of the applicant's immediate family is not acceptable as a reverse side of one copy of the portrait with the words: “I certify that this is a true
recommender. The recommender must be a Citizen of Grenada. likeness of the holder Mr. /(Mrs./Miss ..............................” and add his signature.

DOCUMENTS TO BE PRODUCED All nationals in the Diaspora with a lost damage or stolen passport must make
(A) Any person who surrenders with this application a previous machine application for replacement at any one of the nearest embassy/consulate/Mission
readable passport establishing his/her identity and nationality will not normally office in the country of residence.
be required to produce any other documents unless the person’s name or status
has been changed. CHILDREN UNDER THE AGE OF 16 YRS. may not be granted a passport
without the written consent of the legal guardian i.e. the father, or if the father is
(B) Males (married or single) and female who have not been married and dead, the mother or in the case of a child born out of wedlock the mother. If the
children should produce birth certificate or certificate of naturalization or father and mother are dead, a written consent from the person who has legal
registration as a citizen of Grenada as the case may require. custody of the child must be submitted. Proof of legal custody must be submitted
also.
(C) Married women (including widows and women whose marriage have been
EMERGENCY CONTACT
terminated) should produce marriage certificate or divorce certificate where It is important to provide information on the person who may be contacted in the
applicable. event of an emergency.

PLEASE PRINT YOUR ANSWERS IN THE SPACES BELOW WHERE APPLICABLE.

Signature of Passport Holder in the middle of the space provided.
+ ,
X
. -
Note: Leave this space blank if applying for a passport for a person unable to sign.

Personal Data
1.
G Mr. Marital Status:
G Mrs. G Single G Widowed
G Miss. G Married G Re-married
Other G Divorced G Separated

SURNAME:
(in block capitals) DAVID
CHRISTIAN NAME(S):

MAIDEN NAME: KHOURY

If name has been changed other than by marriage, state original name.

Date of Birth (dd\mm\yyyy) Place of Birth: Age last Birthday: Nationality:

29 12 2005.
................../......................../...................... 18 Lebanese
Sex Height Colour of Eyes Special Peculiarities (Visible)
G Male
Colour of Hair
G Female ft. ins.

Country of Residence Lebanon Present Address Permanent Address Telephone

Fax
Occupation
E-mail
Student
2. IF MARRIED, DIVORCED, SEPARATED OR WIDOWED GIVE INFORMATION ON SPOUSE OR FORMER SPOUSE.

First Name: Middle Name: Maiden Name

Date of Marriage Place of Marriage Country of Birth

(dd\mm\yyyy)
Nationality
............../............./............

Profession or Occupation State whether married more than once ................. If more than
once, particulars of previous marriage or marriages should be
given in Section 10 page 3.
Permanent Address

Mailing Address

Telephone Home: Business Fax: E-mail

3. Particulars of Parents

Father First Name Middle Name Surname Date of Birth Place of Birth

Mother Name First Name Middle Name Surname Maiden Name Date of Birth Place of Birth

Place of Marriage Date of Marriage Country of Marriage

Profession

4. CITIZENSHIP OF PASSPORT HOLDER

Citizen of Grenada by:

G Naturalization G Investment
G Birth
G Registration
G Descent

If citizen of Grenada by Descent attach birth certificate of parents(s) to establish parental claim. If citizen of Grenada by naturalization, registration or
investment give particulars of registration or naturalization certificate and attach a certified copy of same

Type of Certificate Certificate No. Date of Issue Place of Issue

5. Person born in any foreign country must complete particulars of parent(s)

If born in Grenada attach Birth certificate Place of Birth Date of Birth

Name:

If Citizen of Grenada by naturalization Type of Certificate Certificate Number Date of Issue Place of Issue
Registration or Investment

6. PASSPORT REQUIRED FOR TRAVELLING TO:

France
PURPOSE OF TRAVEL:

Student
7. Particulars of previous passport which has been lost or is not available for present use.
NOTE: A police report must be submitted with the application, together with proof of citizenship.

Passport Number Date of Issue (dd\mm\yyyy) Place of Issue

Bearer’s full name at time of issue Place of loss Date of loss (dd\mm\yyyy)

What measures were taken at time to report loss and to obtain recovery?

How did lost occur?

Has loss been reported to the Police? (If yes, attach copy of police report)

8. CONTACT IN CASE OF EMERGENCY

Surname: Christian Name(s) Telephone

Fax

E-mail

Address:

Relationship:

9. PARENT’S CONSENT (See note on page 1)

I (name) ...................................................................................................................................... the (relationship) ................................................................

of name(s) .......................................................................................................................................................................................hereby give my consent

for him/her to hold a passport.

Signature ..................................................................................................

10. SUPPLEMENTARY INFORMATION

...................................................................................................................................................................................................................................................

...................................................................................................................................................................................................................................................

...................................................................................................................................................................................................................................................

...................................................................................................................................................................................................................................................

...................................................................................................................................................................................................................................................

11. DECLARATION OF APPLICANT OR DECLARATION ON BEHALF OF CHILD UNDER THE AGE OF 16 YEARS WHERE APPLICABLE

A I declare that the information given in the application is correct to the best of my knowledge and belief, and

B That I have not lost the status of citizen of Grenada.

Choose C, D or E whichever is applicable

C That I have not held or applied for any passport whatsoever.

D That all previous Grenadian passports granted to me have been surrendered other than passport or travel document number...........................
which is now attached and that I have made no other application for a passport since the passport or travel document was issued to me.

E That I have lost the previous passport.

I certify that I have read and understood all the questions set forth in this application and the answers that I have furnished on this form are true and
correct to the best of my knowledge and belief. I understand that any false, incomplete of misleading information may result in delays in the issuance of a
passport and can lead to having criminal proceedings taken against me. I understand that a passport is the property of the Government of Grenada and can
be recalled at any time.

Signature: ...................................................................................................... Date .......................................................................................

Relationship of applicant to passport holder:.....................................................................................

12. DECLARATION OF RECOMMENDER

I (name in capitals) ........................................................................................................................................................ a citizen of Grenada declare that to

the best of my knowledge and belief the declaration of Mr./Mrs./Miss. ........................................................................................................... are true and
that I can from my personal knowledge of him/her vouch for him/her as a fit and proper person to receive a passport. I have known the applicant
for ......................... years.

This .........................day of ................................................. 20 ............ Signature: .................................................................................................

Profession: ............................................................................................. Address: ...................................................................................................

Telephone No: ........................................................................................ E-mail:......................................................................................................

FOR OFFICIAL USE ONLY

DOCUMENTS PRODUCED TO BE NOTED HERE

Applicant’s Birth Certificate Previous Passport Parent(s) Birth Certificate Marriage Certificate Affidavit where necessary
where applicable

Divorce Certificate Registration, Investment or Letter of Consent Deed Poll Photos

Naturalization Certificate

OTHER DOCUMENTS

PLACE WHERE APPLICATION WAS RECEIVED:

St. George’s, Grenville, Carriacou, Gouyave, New York, Washington, London, Canada, Venezuela, Trinidad, Other specify (.............................. ........................)

Receipt No. ...........................................................................

Application Received by ............................................................................................ Date .................................

Amount
of Fees Paid
Checked and Approved by ......................................................................................... Date ................................
100,000$
Passport:
Supervised by .............................................................................................................. Date ...............................

Passport No. ................................................................................................................

0$
Emergency
01/01/2024
Date Issued ...................................................................................................................
Service:

01/01/2034
Date Expired ................................................................................................................ 50,000$
Express
Service:
Authority Signature .....................................................................................................

Total: 150,000$

DISTRIBUTION

Delivered to ............................................................................................................... Date ...............................

Delivered by ............................................................................................................... Date ...............................