EMBASSY OF PAKISTAN
MADRID
REPORT OF LOSS OF PASSPORT

1. Name of the passport holder: .....................................................................................................................................................
2. Father's/Husband's name:............................................................................................................................................................
3. Place and date of birth: ..............................................................................................................................................................
4. Full address in foreign country: ..................................................................................................................................................
5. Full address in Pakistan: ............................................................................................................................................................
6. Profession: ...............................................................................................................................................................................
7. Number of lost passport: .........................................................................................................................................................
8. Date of issue of passport: .......................................................................................................................................................
9. Office of issue of passport: .....................................................................................................................................................
10. Countries for which passport was endorsed: ........................................................................................................................
11. Period of validity of passport: .............................................................................................................................................
12. Date and place of renewal, if any: ......................................................................................................................................
13. Personal description of holder:
  a) Height:........................................................................................................................................
  b) Colour of eyes: .........................................................................................................................
  c) Colour of hair: .........................................................................................................................
  d) Visible marks of identification:....................................................................................................
14. Date of arrival in the country abroad: ................................................................................................................................
15. Date and place of loss of passport: ..................................................................................................................................
16. Circumstances of loss of passport: ..................................................................................................................................
17. Particulars of report to the poice (if any).............................................................................................................
 

(Signature of the applicant)
Photograph