Form DS-3053, Statement of Consent Instructions
This form contains 21 fields organized into 7 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Applying Adult Info | ||
| Applying Adult's Name (LAST, FIRST MIDDLE) | Text |
Enter the full name of the adult appearing in person to apply for the child’s passport, written as LAST, FIRST MIDDLE exactly as it should appear on the passport application.
|
| Legal Parent | Checkbox |
Check this box if the adult appearing in person to apply for the child is the child’s legal parent.
|
| Legal Guardian | Checkbox |
Check this box if the adult appearing in person to apply for the child is the child’s court-appointed legal guardian.
|
| Third Party | Checkbox |
Check this box if the adult appearing in person to apply for the child is neither a legal parent nor legal guardian (a third party).
|
| Child Information | ||
| Check box if age 16 or 17 | Checkbox |
Check this box when the child’s birthdate on the form indicates the child is 16 or 17 years old.
|
| Child's Name (Last, First Middle) | Text |
Enter the child's full name exactly as it appears on the passport application, in the order Last, First, Middle.
|
| Child's Birthdate | Date |
Enter the child's date of birth. Fill only if 'Check box if age 16 or 17' is age 16 or 17.
Depends on:
Check box if age 16 or 17
|
| Consent - Legal Parents Names | ||
| Non‑Applying Legal Parent/Guardian Full Name (1) | Text |
Enter the full name (last, first, middle) of the first legal parent or legal guardian who cannot appear in person to consent to the child's passport application.
|
| Non‑Applying Legal Parent/Guardian Full Name (2) | Text |
Enter the full name (last, first, middle) of the second legal parent or legal guardian who cannot appear in person to consent to the child's passport application.
|
| Issuance Restrictions or Special Instructions | Text |
If applicable, enter any limitations or special instructions regarding the passport issuance (for example, “Issue passport book only” or other written restrictions).
|
| First Non-Applying Legal Parent/Guardian Address and Contact Details | ||
| Non-Applying Parent/Guardian Street Address | Text |
Enter the full street address (house number, street name, and apartment or unit if applicable) of the non-applying legal parent or guardian.
|
| City, State/Country, ZIP Code | Text |
Enter the city, state (or province), country and ZIP/postal code for the non-applying legal parent or guardian, separated as appropriate.
|
| Phone Number | Text |
Provide a phone number where the non-applying legal parent or guardian can be reached, including area code and country code if calling from outside the U.S.
|
| Email Address | Text |
Provide a current email address for the non-applying legal parent or guardian.
|
| Form Controls | ||
| Reset | Button |
This button resets the form, clearing all entered data. Use this if you need to start over with filling out the form.
|
| Oath/Affirmation Section Header | ||
| Section 4 Oath/Affirmation — Sign Here Instruction | Checkbox |
Check this box only when you have been instructed to sign Section 4 by a Passport Authorizing Officer or notary and you are prepared to make the oath/affirmation; do not check it beforehand.
|
| Second Non-Applying Legal Parent/Guardian Address and Contact Details | ||
| Check box if same as 1 | Checkbox |
Check this box if the second non-applying legal parent/guardian’s address and contact details are the same as the information entered for Non-Applying Legal Parent/Guardian 1.
|
| Non-Applying Parent/Guardian — Street Address | Text |
Enter the full street address of the non-applying legal parent or guardian, including apartment or unit number if applicable. Fill only if 'Check box if same as 1' is 'No'.
Depends on:
Check box if same as 1
|
| Non-Applying Parent/Guardian — City, State/Country, ZIP Code | Text |
Enter the city and either the U.S. state and ZIP code or the foreign country and postal code for the non-applying legal parent or guardian. Fill only if 'Check box if same as 1' is 'No'.
Depends on:
Check box if same as 1
|
| Non-Applying Parent/Guardian — Phone | Text |
Enter a primary contact phone number for the non-applying legal parent or guardian, including country and area codes as needed. Fill only if 'Check box if same as 1' is 'No'.
Depends on:
Check box if same as 1
|
| Non-Applying Parent/Guardian — Email Address | Text |
Enter the email address where the non-applying legal parent or guardian can receive correspondence about the child's passport. Fill only if 'Check box if same as 1' is 'No'.
Depends on:
Check box if same as 1
|