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Hould be completed ONLY by the identifying witness. 1. Passport Applicant's Name (Last, First, Middle) 2. Basis of your knowledge concerning the Passport Applicant (Such as your relationship to the applicant) 3. How long have you (The Witness) known the Passport Applicant? Years Months WITNESS INFORMATION 4. Witness' Name (Last, First, Middle) 5. Witness' Residential Address City, State, ZIP Code 6. Witness' Place of Birth (City, State, Zip Code) 9. Witness Home Telephone Number 8. Witnes.

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