Fillable Form DS-10 (2020)

What is Form DS-10?

Form DS-10 or also known as the Birth Affidavit Passport Form is a single-page document by the U.S. Department of State. It provides a legal statement that bears witness to the circumstances of your birth for the purpose of establishing your identity and U.S. citizenship. It is filled out and sworn to by an individual personally familiar with the details of your birth, or physically present at the time of your birth. A birth affidavit is considered a secondary form of evidence of U.S. citizenship.

Where to get Form DS-10?

A blank copy of the Form DS-10 that you can download and manually fill out is available on the U.S. State Department website.

The affiant fills out the information and presents the unsigned affidavit in person to a Passport Agent, Passport Acceptance Agent, or Notary Public who administers an oath to the affiant swearing to the facts of the statement under penalty of perjury. The affiant then signs the affidavit, and the official agent then notarizes the affidavit.

For your convenience, you may electronically fill out Form DS-10 on PDFRun.

How to fill out Form DS-10?

Here is a detailed guide on how to fill out Form DS-10:

Item 1 - Name of Applicant Whose Birth in the United States is to Be Proved

Last

Enter the last name of the applicant.

Suffix (Jr., Sr., III)

Enter the suffix of the applicant, if applicable.

First

Enter the first name of the applicant.

Middle

Enter the middle name of the applicant.

Item 2 - Applicant’s Sex

Mark the appropriate box to determine the sex of the applicant. You may select:

• Male
• Female

Item 3 - Applicant’s Date of Birth

Enter the date of birth of the applicant.

Item 4 - Applicant’s Place of Birth (City and State)

Enter the place of birth of the applicant including the city and state.

Item 5 - Applicant’s Current Home Address

Street

Enter the street where the applicant resides.

Apartment/Unit

Enter the apartment or unit number of the applicant.

City

Enter the city where the applicant resides.

State

Enter the State where the applicant resides.

ZIP Code

Enter the ZIP Code where the applicant resides.

Item 6 - Number of years you have known the applicant

Enter the number of years you have known the applicant.

Item 7 - Your relationship to the applicant or the basis of your knowledge regarding the applicant

Enter your relationship to the applicant or the basis of your knowledge regarding the applicant.

Item 8 - State all the facts you know about the applicant’s birth

Enter all the facts you know about the applicant’s birth. The detailed statement should include the date, time, location of the applicant’s birth, individuals present, and any other first-hand knowledge of the event or how you obtained the knowledge of the event. List the names of the applicant’s birth parents and your relationship to the applicant and birth parents. Attach a separate piece of paper if more space is needed.

Printed Name of Affiant

Enter the name of the affiant in printed form.

Signature of Affiant

Enter the signature of the affiant.

Affiant Social Security Number

Enter the Social Security Number of the affiant.

Affiant’s Date of Birth

Enter the date of birth of the affiant.

Address of Affiant (Number and Street, City, State, and ZIP Code

Enter the address of the affiant, including the apartment or unit number, street, city, state, and ZIP code.

Identifying Documents Presented

Mark the appropriate box to determine the identifying documents presented. You may select:

• Driver’s license
• Passport
• Military ID
• Other — If marked, specify what document is presented.

ID Number

Enter the ID number of the document presented.

Place of Issue

Enter the place of issue of the document presented.

Issue Date

Enter the date issued of the document presented.

Expiration Date

Enter the date of expiration of the document presented.

Subscribed and sworn to before me this day of

Enter the date when this form is subscribed and sworn.

Name of Passport Agent, Acceptance Agent, or Notary Public

Enter the name of the passport agent, acceptance agent, or the notary public.

Location (Passport Agency, or city and state)

Enter the passport agency or the city and state where this form is filed.

Information and reminders on filing Form DS-10

Here are some information and reminders in filing Form DS-10:

• A birth affidavit may be submitted with an application for a U.S. passport when an acceptable birth certificate cannot be obtained for a person born in the United States.
• The affidavit must be accompanied by a photocopy of the front and back side of the affiant’s identification and, when applicable, a notice from the appropriate authorities indicating that no birth records exist
• A birth affidavit may also be submitted in conjunction with birth records.
• A birth affidavit must be made by an individual who has personal knowledge of the facts of the applicant’s birth in the United States. It is preferred that the affidavit is made by an older blood relative or an attending physician.
• The affidavit must be signed in front of a notary unless it is being submitted to an authorized passport acceptance facility.
• The affidavit shall state briefly how the affiant’s knowledge was acquired
• Requests for copies of this affidavit should be made at the time of execution.
• Provide true and accurate information. Any false information provided in the affidavit will be under penalty of perjury.
• The collection of the Social Security Number (SSN) will be used to verify the identity only and for no other purpose unless authorized by law.
• Information in this affidavit may be disclosed to another domestic agency, a private contractor, a foreign government agency, or to a private person or private employer in accordance with certain approved routine uses.
• Providing your Social Security Number and the other information on this form is voluntary, but failure to provide the requested information may result in processing delays or denial of your application.
• Review your application. Check for errors in your form.