EFTA02310784.pdf

1. Traveler Name Date of Birth 2. Traveler Name Date of Birth Date of Travel VISAS & PASSPORTS Second Valid Passport Traveler Information Applicable Fees Date Documents Must Be Returned Shipping and Contact Information US Government Fee Second Valid Passport 5170.00 G3 Processing Fees 2 Business Days or Less' $250.00 6 Business Days 517500 'If you WWI° IOU 140G 2 business day service. you must contact 63 to marvel your passport plOCesSmg Slot Ca must mauve all paperwork no lay thane-30AM via FedEx ot UPS wth no stgrtatute favored. me must Le a physicals:Wins lot Fedex *fifers no PO. Ogres. Shipping Fees Passpons mil be serum& ma Federal Express. Attention: 3 Business Day Delivery $15.50 Company Name: Overnight Delivery $23.50 Street Address: 8 AM Delivery— $75.00 Apt./Suite: Saturday Delivery— $38.50 City: Same Day Delivery Please Call State: Zip Code: **These somas may not Ce eva4ItVe to strip codes International &Ivory is evs4We Home Phone: Mobile: Office Phone: Fax: Payment Information Email Address: Please include your email address so we may email you status and shipping updates. Send This Form and All Required Documents To: G3 Miami: 80 SW 8th Street. Suite 2250 Phone Miami. FL 33130 oll Free G3 Washi , DC: 3300 N Fairfax Drive. Suite 220 i Phone Arlin ton, VA 22201 Select Payment Type: Credit Card °Check (company or certified) ElEstablished Corporate Account t/ Total Fees: Fee xi/ of Travelers Total US Government Fee SiTO 00 x = $0.00 G3 Processing Fee X = $0.00 Shipping Fee oil Free Subtotal: Soso Add 5% lee for credit card processing so co G3 Chicago: 11 East Adams. Suite 1605 Total Payment Enclosed: so oo Phone Toll Free 'Loss MvaStsiseass dzoy safety a orstolds ore !emcee bats an1 eusf On nssecred sr advance by caSeg GS Cradt castamp esloonnee moved prott iests making a raven Avon el Melee roe kepi wit* dewed Ae GSpeces.sw keel udess cenceSel 24 Cann eMadas 03 Vsss s Passports lac env on the behol/ of the dem arc/cannot be het Ledo Ms the services coskrec Sy US Govanneol opened, Post 010cws ItandApendoe ernes Autos •I7 Las wowed, meter pawndpeoceszuhg GJ s,cAsers any MAW fee delsys clam a passpoeN es /worn% through above 5011COS or by any deOnny saw° Newt. comedisidon is not ended° For Payment Via Credit Card: Andra. Eyes. IttUstuCard end Ku any Name as it appears on card: Account Number: Expiration Date: Security Code: (Amnesia Swint 4 dot cods on end card sisnerCaos or less apf code on bad of card) Cardholder Signature: Billing Zip Code Kovno. UTIO.,. EFTA_R1_01195124 EFTA02310784 VISAS & PASSPORTS Second Valid Passport Required Documents Checklist: K Your current 10 year passport. The passport must be valid and signed. If your passport will expire in less than one year, the Passport Agency will require that you renew your passport before applying for a second valid passport. K Passport Form DS-82, "Application for Passport by Mail." This must be completed online at httpsAp_ptform.state.qov/PassportWizardMain.aspx ("Apply for a Passport Book"). The application must be completed, printed out, signed and included in your package to G3. An original signature, preferably in blue ink, is required; no faxes, scans or copies will be accepted. Instructions on filling out the online passport application are available at http://www.a3visas.com/v2/Passport3.html. K Two NEW passport-style color photographs, taken within the last six months. The photos must be identical and printed on high-quality photo paper, and must have a white or off-white background. Photos that have been used for a previously issued passport are not acceptable. The photos must measure 2"x2" and meet the head size criteria specified at http://travel.state.gov/passport/guide/faq/faq 881.html. No uniforms, sunglasses or hats are allowed, except for headgear worn daily for religious reasons. A signed letter from the applicant must be included explaining that the item is worn daily for religious reasons. K G3 Letter of Authorization, completed and signed. The Letter of Authorization (LOA) allows G3 to represent you to all agencies involved in issuing your passport. Please complete all LOAs so all of our companies have the ability to process your request. The signature on the LOA must be original, no faxes, scans or copies will be accepted. K Second Valid Letter of Request. This letter must explain one of two reasons for needing a second valid passport, and must be signed by the applicant. o The letter may demonstrate trips arriving and departing in close proximity, making it difficult to acquire the visas needed for the second trip. o The letter may demonstrate previous trips to the Middle East that would create difficulties in entering another Middle Eastern country. The proof of departure must show the specific trips described in the letter. A sample letter is attached for your review. K "Request for a Second Valid Passport" Form. This form must be completed and signed in addition to the Letters of Authorization and Second Valid Letter of Request. K Proof of Departure. Submit a copy of your flight itinerary, airline tickets, or a letter from your company (on company letterhead) stating that there a second valid passport is required for business travel. This letter must be signed by a representative of the company other than the applicant and must specify the applicant's departure date(s) and destination(s). 5/2412011 EFTA_R1_01195125 EFTA02310785 M IMI VISAS &PASSPORTI, June 1, 2010 U.S. Passport Office Department of State Sample Second Valid Passport Letter of Request from Applicant Please print your letter on company letterhead******* To Whom It May Concern: I work for [COMPANY NAME] as a/an [OCCUPATION] and travel internationally with great frequency. As a consequence, my passport is with me when I travel abroad, and I cannot obtain visas for the trips that are planned while I am out of the country, which causes undue hardships and much inconvenience. I am currently traveling to India on June 15, 2010, and will be returning to the United States on June 25, 2010. On July 1, 2010, I will be traveling to Brazil, and visas are necessary for this trip. fPlease note that the dates of TWO trips are required, within one week of another, the second trip requiring visas.! Please issue me a second valid passport, so I can have the visas issued while I am on the first trip. I understand that the passport will only be valid for a limited period. If you have any questions, please feel free to call me at [phone number'. Should either my original 10 year passport or my limited validity (second valid) passport be lost or stolen, I will report the circumstances immediately to the Passport Office in Washington, DC, or, if abroad, to the nearest US Embassy or Consulate. Thank you for your assistance with this matter. Sincerely, SIGNED BY THE APPLICANT PRINTED NAME OCCUPATION COMPANY NAME EFTA_R1_01195126 EFTA02310786 Letter of Authorization U.S. Passport Office U.S. Passport Office U.S. Passport Office U.S. Passport Office Washington Passport Agency Chicago Passport Agency Houston Passport Agency Miami Passport Agency Washington, DC Chicago, IL Houston, TX Miami, FL Date: To Whom It May Concern: , hereby authorize a representative of G3 Visas & Passports to submit my passport application, discuss its status and retrieve it upon completion. I intend to depart the United States on My date of birth is I am traveling to and visas are required required for my upcoming trip. (Place a check mark) , or are not Under the Provision of the Privacy Act of 1974 (Public Law 93-579) No information may be released from U.S. Government files without the prior written consent of the individual in question. Consequently, an employee of the U.S. Passport Agency cannot discuss the details of your passport application with the courier service without your permission. Thank you for your assistance with my application. Original Signature of Applicant Washington, DC Office 3300 N. Fairfax Drive Suite 220 G3 Visas & Passports US Offices Chicago, IL Office 11 East Adams Suite 1605 Houston, TX Office 2425 West Loop South Suite 200 Miami, FL Office 80 SW 8th Street Suite 2250 EFTA_R1_01195127 EFTA02310787 Letter of Authorization U.S. Passport Office Washington Passport Agency Washington, DC Date: To Whom It May Concern: U.S. Passport Office Houston Passport Agency Houston, TX U.S. Passport Office Philadelphia Passport Agency Philadelphia, PA , hereby authorize a representative of Global Passports & Visas, Inc. to submit my passport application, discuss its status and retrieve it upon completion. I intend to depart the United States on My date of birth is I am traveling to and visas are required required for my upcoming trip. (Place a check mark) , or are not Under the Provision of the Privacy Act of 1974 (Public Law 93-579) No information may be released from U.S. Government files without the prior written consent of the individual in question. Consequently, an employee of the U.S. Passport Agency cannot discuss the details of your passport application with the courier service without your permission. Thank you for your assistance with my application. Original Signature of Applicant Global Passports & Visas, Inc. Washington, DC Office 3300 N. Fairfax Drive Suite 220 11111 111111 US Offices Houston, TX Office 2425 West Loop South Suite 200 EFTA_R1_01195128 EFTA02310788 REQUEST FOR A SECOND VALID PASSPORT TO THE PASSPORT AGENCY. DATE (Complete Type I or Type II which ever paragraph is applicable.) TYPE I: I hereby certify that it is necessary for me to have a second passport valid only for travel to (a) Because the stamp(s) in my present passport will not allow nu to travel to (b) Because my itinerary requires that I travel first to arid then to . I am unable to change my travel plans. TYPE II: I hereby certify that a second valid passport is necessary because my present passport will be advised for travel to . I have been informed it will take at least days. While my present passport is being visaed, I will be traveling to from to I understand that (if TYPE I above applies) one of the passports will be restricted for travel only to I understand that (if TYPE II above applies) the second passport will be limited in time to cover this one trip. I agree to report without delay the loss of either passport to the nearest United States Embassy or Consulate abroad, or to a passport Agency in the United States. SIGNATURE NUMBER OF CURRENT PASSPORT: DATE ISSUED: EFTA_R1_01195129 EFTA02310789 APPLICATION FOR A U.S. PASSPORT BY MAIL 'SIR APPROVAL NO 1105.11)10 EXPIRATION DATE: 1241.2010 ESTIMATED BURDEN.1O MIN Attention: see WARNING on page two of instructions Please select the document (or documents) for which you are applying: E U.S. Passport Book K U.S.:222ort Card The U.S. passport card may city be used for international travel by land or the United States, Canada. mode°, the Caribbean and Bermuda. PitaSe riot our detailed information. 1. Name Last DOE First & Middle O JOHN I OR EID 00 OOP End. a Exp 3. Sex EMDF 4. Place of Birth (City & State or City & Count ' is presently known) CITY OF BIRTH, AL 6. Mailing Address: Street/RFD # or P.O. Box 2. Date of Birth (ram/dd./MT) 01 01 1970 5. Social Security Number 999 99 9999 STREET WHERE YOU LIVE City SO Zip Code (Zip + 4 if known) CITY WHERE YOU LIVE 12345 A 7. Contact Phone Number ®Home I:Cell El Work 8 Em pional) (O t 123 - 456 - 7890 YOU L@EMAIL.COM 9. Have You Ever Used A Different Name (Maiden, Previous Marriage, Legal ame Change)? If yes, please complete. (Mao) additional pages if needed) Apartment or unit 47 In Care Of or Country, if applicable 10. Passport Book or Pastr ecrd Information Your name as listed on you ent passport or passport card JOHN DOE Most recent pa or passport card 111111111 11. Name Change Inform 0 Changed by Marriage 0 Changed by Court Order Please submit ma Issue date (mrrVdd/yyyy) 01/01/1998 Complete if name is different than last passport book or passport card e of Name Change (City/State) Date (mm/ddlyyyy) certificate or court order to support your name change CONTINUFerp PAGE 2 YOU MUST SIGN AND DATE THE APPLIUMON IN THE DESIGNATED AREA BELOW I declare under penalty of perjury all of the following: 1)1 am a citizen or non•citizen national of the United States and have not, since acquiring U.S. cibzenship or nationality, performed any of the acts listed under 'Acts or Conditions" on the reverse side of I a licabon (unless explanatory statement is attached); 2)the statements made on the application are true and correct; 3)1 have not knowingly and willfully made fal nts or included false documents in support of this application- 4)the photograph submitted with this application is a genuine, current, photograph of me; and 5)I ha d understood the waming on page two of the instrucbons to the application form. Applicant's Signature 0 Date This section for issuing office only CI Marriage Certificate 0 Court Order 0 Other: Date of Marriage/Place Issued: Date Filed/Court: C r Please go to https://pptform.state.gov/PassitortWizardMain.asps ° Atrcreate yotir DS-82 applicatipn form online EF Postage Other upplinuml I PPT Fee DS-82 02-2008 Pa e 1 of 2 EFTA_R1_01195130 EFTA02310790 Name of Applicant (Last, First & Middle) Date of Birth (mm/dd/yyyy) DOE , JOHN 01/01/1970 12. Height 13. Hair Color 14. Eye Color 15. Occupation 16. Employer 6ft. Oin. Brown Brown BUSSINESS PERSON ACME, INC 17. Additional Contact Phone Numbers • • Home Work M Cell 0 El Home 0 Work 0 • Cell 18. Permanent Address: Street/RFD # (No P.O. Box) Apartment or unit ft STREET WHERE YOU LIVE City State Zip Code CITY WHERE YOU LIVE AL 12345 19. Emergency Contact - Provide the information of a person not travel th you to be contacted in the event of an emergency. Name Address: Street/n or P.O. Box Apartment or unit x JANE DOE STREET VIMRE SHE LIVES City State Zip Code U m, Phone Number Relationship CITY WHERE SHE LIVES AL 12345 elk 1234567890 I WIFE 20. Travel Plans Date of Trip (mm/dd/yyyy) Length of Trip Countries to be ' ed 08/08/2008 10 DAYS CHINA STOP! YOU HAVE COM • BE SURE TO SIG 2 ira D YOUR APPLICATION a, DATE PAGE ONE (.O el. L^ < 0 2 < (O Please go to https://pptform.state.goy/PassportWizardMainsaspx to create your DS-82 form online. INIIIIIIIIIIIIIIII1IIIIIIIIIIIIIIIIII C .'10 072 III DS-82 02-2008 P ge 2 of 2 EFTA_R1_01195131 EFTA02310791