Passport Form DS-10 Birth Affidavit

The purpose of passport document DS-10 is to allow you to submit a birth affidavit, along with your application for a US passport, when an acceptable birth certificate cannot be obtained for a person born in the United States.

You must provide 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 record exists along with this affidavit. This document can also be submitted in conjunction with other 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 US. They prefer the affidavit is made by an older blood relative or by the attending physician.

The affidavit must be signed in front of a notary, unless it is being submitted to an authorized Passport Agent or Passport Acceptance Agent. 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.

Filling out passport form DS-10

Below is a list of fields you will need to fill out once you download this form:

  • Name of applicant whose birth in the US is to be proved
  • Applicant's sex
  • Applicant's date of birth
  • Applicant's place of birth
  • Applicant's current home address
  • Number of years you have known the applicant
  • Your relationship to the applicant, or the basis of your knowledge regarding the applicant
  • State all facts about the applicant's birth
Download instructions

Below are instructions for downloading and printing this document:

  • You will need Adobe Acrobat to view the PDF forms and applications on this page. To download Acrobat Reader, click here
  • When printing the application, make sure the image of the application covers the entire page. You must also print single sided. They will not accept double-sided forms
  • They do not have the ability to accept payments online, so you will not be asked to provide any credit card information
  • Click here to download Form DS-10

If you have questions or issues about this document, please contact a passport office location for further assistance.