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Nigerian Passport Intake Form
Title
Mr.
Mrs.
Ms.
Mx.
Miss
Dr.
Prof.
First Name
*
Middle Name
Last Name
*
Gender
*
Select Gender
Male
Female
Date of Birth
*
Day
Select day
1
2
3
4
5
6
7
8
9
10
11
12
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14
15
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17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
Select month
1
2
3
4
5
6
7
8
9
10
11
12
Year
Select Year
2125
2124
2123
2122
2121
2120
2119
2118
2117
2116
2115
2114
2113
2112
2111
2110
2109
2108
2107
2106
2105
2104
2103
2102
2101
2100
2099
2098
2097
2096
2095
2094
2093
2092
2091
2090
2089
2088
2087
2086
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2084
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2077
2076
2075
2074
2073
2072
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2070
2069
2068
2067
2066
2065
2064
2063
2062
2061
2060
2059
2058
2057
2056
2055
2054
2053
2052
2051
2050
2049
2048
2047
2046
2045
2044
2043
2042
2041
2040
2039
2038
2037
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
Place of Birth
*
Renewal Applicant (Passport Number)
*
National Identity NUMBER (NIN):
Contact Phone No.
*
Email Address
*
Mobile Phone No.
Residential Address
*
Address 2: Apt/Suite/Unit Number
City
*
State
*
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP Code
*
Mailing Address if different from Residential Address
Color of Eye
*
Color of Hair
*
Marital Status
*
Select marital status
Single
Married
Widow
Widower
Divorce
Separated
Height (ft. or cm)
*
Nigerian Residential Address
*
City
*
State
*
Select State
Abuja (FCT)
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Bayelsa
Benue
Borno
Cross River
Delta
Ebonyi
Enugu
Edo
Ekiti
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kogi
Kwara
Lagos
Nasarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
LGA
*
State of Origin
*
Select State
Abuja (FCT)
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Bayelsa
Benue
Borno
Cross River
Delta
Ebonyi
Enugu
Edo
Ekiti
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kogi
Kwara
Lagos
Nasarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
Hometown
*
First Name
*
Last Name
*
Relationship with next of kin
*
Contact number of next of kin
Next of kin's address in Nigeria
*
City
*
LGA
*
State
*
Select State
Abuja (FCT)
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Bayelsa
Benue
Borno
Cross River
Delta
Ebonyi
Enugu
Edo
Ekiti
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kogi
Kwara
Lagos
Nasarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
Maiden name (married women only)
*
Nationality
*
Must be Nigerian
Processing Embassy for Exercise
*
Select embassy
New York
Atlanta
Washington DC
Processing Embassy for Appt
*
Select embassy
New York
Atlanta
Washington DC
I hereby declare that the information given in this application form is correct to the best of my knowledge.
Kindly input full name as it appears on your ID.
Submit
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