DS-3053: Statement of Consent or Special Circumstance for Minor Passport

DS-3053The DS-3053: Statement of Consent or Special Circumstance for Minor Passport is when one parent is applying for a passport for a child without the other parent or has sole custody of the minor. In order to use this application you will have to download the DS-3053 Statement of Consent Application Form this fillable PDF. If parent or guardian has sole custody then this form is not needed.

The State Department requires that parents or guardians fill out the DS-3053 Statement of Consent Application Form. You will need to get a witness and have the document notarized.

The State Department requires that parents or guardians fill out the DS-3053 Statement of Consent Application Form. You will need to get a witness and have the document notarized.

Download the  Statement of Consent or Special Citcumstances

Requirements for DS-3053 Statement of Consent

  •  You are a non-applying parent or guardian providing a written consent for a minor U.S. citizen child to apply for a United States passport because you are unable to apply in person with your child (Statement of Consent) or
  • You are applying parent or guardian, and the written consent of a non-applying parent or guardian.

How to do used the DS-3053 Parental Consent Passport Form?

When applying for a minor passport both parent is required to appear with the minor to obtain the passport for the child. The DS-3053 is used when one of these parent or guardians cannot appear with the child in such as case the following would need to be done.

  •  Date and Sign the DS 3053 Parental Consent Passport Form in the present of a certified notary public and
  •  Submit a photo copy of the front and back of the Identification that was presented to the Notary Public with the DS-3053 form.

How to use the DS-3053 Statement of Special Circumstance?
Please note: This application form should be fill out using black ink, and a Certified Public Notary should witness the signature.

Step 1: Complete Items 1, 2, and 3 which is the minor information such as minor name, date of birth and relationship of minors.
Step 2: Complete Item 4a Statement of Consent should only be filled out if you are a non-applying parent or guardian submit the minor’s application.
Step 3: Notary Public should fill out this section which is the Notary Public Information.
DS-3053 must be submitted along with form DS-11 at an approved agency or acceptance facility within 3 months of the date it was notarized. Any future Statement of Consent from the non-applying parent must be notarized as well.

Processing time for passports is approximately four to six weeks. Expedited processing options are available for additional fees.

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