Main Office:
309 Peters Street SW, Unit A, Atlanta, GA 30313
Tel 1-888-263-0023 or 1-404-827-0099
San Francisco:
3450 Geary Boulevard #105,106,
San Francisco, CA 94118
Tel 1-415-525-2366; 1-415-593-4455
Moscow:
29 1st Tverskaya-Yamskaya Street,
Bldg. 1, Office 6, Moscow 125047
Russia
Tel. 7-495-623-5905, 7-495-2255012, Emergency 7-495-649-6282
Passports for minor Russian children adopted by US citizens/residents and permanently
residing in the US are issued on the basis of their parents’ application. Please fill out the
order form below. Do not leave any fields blank. We ask you to complete as much
information as possible, however, if the answer is "none" or "does not apply" please
write "none" or "does not apply".
Please Note: All parent applicants will need a valid US passport to apply. Go To
Russia Travel can assist U.S. citizens with a full range of expedited passport services
including obtaining a new US passport and
US passport renewal.
Parent Information:
1. Last, First, Middle names as it appears on your passport:
____________________________________________________________________________________________
2. Date of Birth (dd/mm/yy) _______________________________________________________________________
3. Gender:
M____
F_____
4. Place of Birth: _______________________________________________________________________________
5. Passport information
Passport number: ______________________________________________________________________________
Date of issue: __________________
Exp. date:____________________________
Issued by: ____________________________________________________________________________________
6. Employment place and address:
Employer Name: ______________________________________________________________________________
Street address and suite number: _________________________________________________________________
City:______________________________________ State:______________ Zip:___________________________
Position: ______________________________________________________________________________________
7. Residence address: ___________________________________________________________________________
Main Office:
309 Peters Street SW, Unit A, Atlanta, GA 30313
Tel 1-888-263-0023 or 1-404-827-0099
San Francisco:
3450 Geary Boulevard #105,106,
San Francisco, CA 94118
Tel 1-415-525-2366; 1-415-593-4455
Moscow:
29 1st Tverskaya-Yamskaya Street,
Bldg. 1, Office 6, Moscow 125047
Russia
Tel. 7-495-623-5905, 7-495-2255012, Emergency 7-495-649-6282
City:___________________________State_____________________Zip___________________________________
Phone: _______________________________________________________________________________________
Child Information:
8. Last, First, Middle names as it appears on child's passport:
_____________________________________________________________________________________________
9. Date of Birth (dd/mm/yy) _______________________________________________________________________
10. Gender: M_____F__________
11. Place of Birth: ______________________________________________________________________________
12. Adoption Certificate:
Serial Number: _______________________________________________________________________________
Where issued (Country/City) ____________________________________________________________________
Certificate Number: ____________________________________________________________________________
Date of issue (dd/mm/yy) _______________________________________________________________________
Issuing Authority: ______________________________________________________________________________
13. Child Russian Passport Information:
Serial Number: __________ Issue Date (dd/mm/yy)_________Exp. Date (dd/mm/yy)_________________________
Issued by (Country/ Region/Province/State):
Issuing Authority
_____________________________________________________________________________________________
14. Child School information ______________________________________________________________________
Started attending school (dd/mm/yy) ________________________________________________________________
School name: _______________________________Current Level________________________________________
Main Office:
309 Peters Street SW, Unit A, Atlanta, GA 30313
Tel 1-888-263-0023 or 1-404-827-0099
San Francisco:
3450 Geary Boulevard #105,106,
San Francisco, CA 94118
Tel 1-415-525-2366; 1-415-593-4455
Moscow:
29 1st Tverskaya-Yamskaya Street,
Bldg. 1, Office 6, Moscow 125047
Russia
Tel. 7-495-623-5905, 7-495-2255012, Emergency 7-495-649-6282
Address:______________________________________________________________________________________
City: _________________________ State: ________ Zip_____________________
Second Parent Information:
15. Is the Second Parent information available?: Yes ___________ No____________________________________
If No, give reason for the absence of information:
____________________________________________________________
If your answer to the above question is "YES" then complete the following information:
16. Last, First, Middle Name_____________________________________________________________________
17. Residence address:_________________________________________________________________________
Street Address:________________________________________________________________________________
City:____________________State:__________________Zip:____________________________________________
18. Passport information:
Passport number: _____________________________________________________________________________
Issued by (Country/Region/Province/State)___________________________________________________________
Date of Issue (dd/mm/yy)______________________Date of Exp. (dd/mm/yy)________________________________
Issuing Authority:_______________________________________________________________________________
6. Employment information:
Employer Name:________________________________________________________________________________
Street address and suite number:__________________________________________________________________
City:______________State______________Zip:_______________________________________________
Telephone:____________________________________________________________________________________
Position:_____________________________________________________________________________________
Main Office:
309 Peters Street SW, Unit A, Atlanta, GA 30313
Tel 1-888-263-0023 or 1-404-827-0099
San Francisco:
3450 Geary Boulevard #105,106,
San Francisco, CA 94118
Tel 1-415-525-2366; 1-415-593-4455
Moscow:
29 1st Tverskaya-Yamskaya Street,
Bldg. 1, Office 6, Moscow 125047
Russia
Tel. 7-495-623-5905, 7-495-2255012, Emergency 7-495-649-6282
19. Comments:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Form completed by: ____________________________________________________________________________
___________________(parent signature)
Date: dd/mm/yy __________________________