Passport and Extras LLC  
8046 ROSWELL RD, BUILDING 200, SUITE 204 (BACK BUILDING), SANDY SPRINGS, GEORGIA 30350

Tel. No. 678-939-5580/770-330-9229/6789044770

NOTE: For the renewal of your expired or new passport, kindly complete the required details on this application form. 

Please complete this form in CAPS and make sure that all the details are filled correctly (spellings, and complete) before hitting the submit button.
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REFFERAL CODE
How would you like your biometric enrolled?

Note:
Self Enrollment -The government will charge you an additional $100 for using the Nigerian Immigration System Software. *
Required
Are you applying for: *
Required
Change Type *
Required
Age Group *
Required
Current Passport No# (Nigerian Passport)
Occupation *
Standard ePassport Application Data Collection Form (For Nigerians in the United States)  

Title
First Name (As on NIN/Current passport/Doc)  *
Middle Name  (As on NIN/Current passport/Doc)
Surname/Last Name  (As on NIN/Current passport/Doc) *
Mother's Maiden Name *
Gender *
Required
Email *
US Phone/Mobile number *
NIN Number (National Identification Number)
Please put 00000 if you don't have NIN *
Date of Birth *
MM
/
DD
/
YYYY
Place of Birth 
Please specify your birth city as stated on your Passport/Birth Certificate *
Street Address
Please put your U.S. Street Address
 *
City *
State *
Zip Code *
Marital Status *
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