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 __________________________