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FORMS & OTHER RESOURCES

Passport & Visa Applications


Personal Care / FutureCare Forms

FOR FAMILY / POLICYHOLDER

Request for Benefits 

Physician's Letter

Personal Care Guide / FAQ's

Claim Form - PCB / FutureCare


FOR CAREGIVER

Personal Reference Questionaire

Medical Certificate for Caregiver

Electronic Payments Form - For Caregiver

Company Employment Contract

ADDRESS

54 Reid Street, Suite 201, Hamilton HM 12

CALL US

441 295 5533

Fitness

Bermuda / BOTC Passport Questionnaire 

D

Please answer all questions as we prepare your digital BOTC passport application.

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What type of passport are you applying for?*

Please check which applies*

Who is this passport for?*

Surname*

First and middle names*

Maiden or all previous names

Current Address*

Country*

Postcode*

Date of birth*

Gender*

Town of birth*

Country of birth*

Mobile Phone Number*

Alternative Phone Number

Email Address*

Has the person named had any sort of passport (British or Otherwise) or been included in any passport before?*

If yes, please state passport number(s)

Details of lost or stolen passport

Issued at

In year

Holders surname at the time it was issued

First and middle names

How the passport was lost, or why it is not available

Date of loss

Place of loss

Mother's full name*

Town and country of birth*

Date of birth*

Nationality and citizenship at the time of applicant's birth*

If they have a British Overseas Territories passport give the number

Date of issue

Date of issue

Father's full name*

Town and Country of birth*

Date of birth*

Nationality and citizenship at the time of applicant's birth*

If they have a British Overseas Territories passport give the number

Has the applicant been granted a certificate of registration or naturalization?*

If yes, give date of issue, Certificate number and place of issue

Countersignatury's Full Name

Countersignatory's Email address

How long have they known you, and under what capacity?

Countersignatory's employer and the address they work at

Postcode

Mobile Phone number

Alternative phone number

Current Passport number

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