Identity block
Full legal name, date of birth, and current contact information matching government records for reliable verification.
This affidavit provides a formal, sworn account that passport agencies use to confirm identity, citizenship status, and the reported loss — helping to reduce fraud and establish a clear administrative record under federal passport rules and acceptance procedures.
The affidavit helps officials verify circumstances and supports the replacement process whether submitted at a passport acceptance facility, consulate, or by mail with required passport forms.
| Field | Configuration |
|---|---|
| Name field | Mandatory, exact-match verification enabled |
| Date field | MM/DD/YYYY format with validation |
| Statement field | Free-text zone with 500-character limit |
| Notary block | Conditional field shown when notarization required |
Ensure the chosen delivery method preserves an audit trail and allows exporting a stamped signed PDF for submission with passport forms.
Full legal name, date of birth, and current contact information matching government records for reliable verification.
Naturalization certificate number, issuance date, and issuing authority to connect the affidavit to official citizenship evidence.
Concise, dated description of circumstances surrounding loss or theft, including location and actions taken at discovery.
Include copies of the naturalization certificate, police report if filed, and any previous passport scans to strengthen the application.
A space for a notary signature, seal, and date where the receiving agency or state law requires notarization.
Affiant signature and printed name, with date in MM/DD/YYYY format and witness lines if state rules demand witnesses.
Copy of your Certificate of Naturalization or other documentary proof of U.S. citizenship.
Driver’s license or state ID to corroborate identity and current residence.
If the passport was stolen, include an incident or police report when available.
A photocopy or image of the lost passport if you have it saved digitally.
Report loss immediately to the State Department and local authorities if theft occurred
Submit the affidavit with Form DS-11 (replacement) and Form DS-64 when applicable
Complete notarization before mailing or presenting documents in person
Agency processing times vary by workload and service level selected
Consulates may issue limited-validity emergency documents on expedited timelines
Notify appropriate authorities and record the incident details promptly
Complete the sworn statement, attach evidence, and obtain notarization if required
Send affidavit with the passport replacement application package
Await review and issuance or request for additional information
A U.S. citizen lost a passport while traveling overseas and filed an affidavit with the consulate to obtain an emergency travel document.
A resident reported a stolen passport domestically and completed an affidavit before a notary to support a DS-11 replacement.
| signNow | DocuSign | Adobe Sign | PandaDoc | HelloSign | |
|---|---|---|---|---|---|
| Starting Price | $8/user/mo | $15/user/mo | $14/user/mo | $19/user/mo | $15/user/mo |
| Free Trial | 7-day free trial | Varies by plan | Varies by plan | Varies by plan | Varies by plan |
| Bulk Send | Yes | Yes | Yes | Yes | No |
| Audit Trail | Yes | Yes | Yes | Yes | Yes |
| HIPAA Compliant | Yes | Yes | Yes | No | No |