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Form DS-86 PDF Template

What is a Form DS-86?

Form DS-86, known as the "Statement of Non-Receipt of a U.S. Passport," is a document issued by the U.S. Department of State. It is used by individuals who have applied for a U.S. passport but have not received it within the expected time frame. By submitting this form, applicants declare under penalty of perjury that they have not received their passport and request the issuance of a new one. This form must be completed accurately and accompanied by necessary identification documents to avoid any potential misuse of the original passport, which will be invalidated if later found.


How to Fill in Our Form DS-86 PDF Template

Follow these steps to fill in the Form DS-86 template:

  • Certify Non-Receipt:

    • Confirm that you have not received the U.S. passport book and/or card for which you applied.

    • Declare under penalty of perjury that the statements made on the form are true and correct.

  • Request for Reissue:

    • Request the issuance of a new U.S. passport book and/or card.

    • Agree to contact the National Passport Information Center if you receive the original passport after submitting this form.

  • Previous Passport Details:

    • Provide the previous U.S. passport book number, place issued, date mailed, and any special postage used.

    • Provide the previous U.S. passport card number, date issued, place issued, date mailed, and any special postage used.

  • Personal Information:

    • Enter your last name, first name, and middle name.

    • Provide your date of birth (mm/dd/yyyy).

    • Enter your Social Security Number.

    • Provide your mailing address, including street address, apartment/unit, city, state, and ZIP code.

    • Enter your primary and secondary telephone numbers.

  • Document Selection:

    • Select the document(s) you are reporting as not received (U.S. Passport Book or U.S. Passport Card).

  • Important Notices:

    • Understand that a U.S. citizen may not hold more than one valid U.S. passport book and one valid U.S. passport card at a time.

    • Report the non-receipt of your passport within 90 days of issuance to avoid reapplication and full fee submission.

    • Visit travel.state.gov or contact NPIC to check the status of your passport application.

  • Signature and Date:

    • Sign and date the form if you are 16 years or older.

    • If the applicant is under 16, a mother, father, parent, or legal guardian must sign the form.

  • Notary Section (Passport Office Use Only):

    • Verify if the passport was mailed to the correct address.

    • Confirm delivery status and tracking information.

  • Identification:

    • Attach a clear photocopy of the front and back of an identification document containing your photograph.

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