Free online tool

USADV-4 Lost Chinese Passport Statement

Fill in the form and download a PDF — your answers are printed onto the official consulate form. Print it and sign by hand.

When you need it

Required when a former Chinese citizen cannot provide the original of their last Chinese passport. Write 无 (none) for anything you cannot provide. The form has two signature fields, both signed by hand. Per item 3 on the form, also attach a printout of your exit-entry documents from the National Immigration Administration website or mini-program.

All Chinese passport details can be looked up in the National Immigration Administration (国家移民管理局) mini-program on WeChat or Alipay. Please also attach a screenshot of the mini-program lookup when submitting. This is a Chinese-language form — please answer in Chinese where you can (names and numbers may be in English).

Please read before you start

Formatting only. Your answers are printed onto the official form exactly as typed; we do not verify or guarantee their accuracy.
The signature fields are blank. Print the form and sign by hand (a guardian signs for applicants under 16 as the form explains). Electronic signatures are not accepted.
Acceptance is up to the consulate. We cannot guarantee the form will be accepted; always follow the consulate's latest notice.
Please be truthful. False or incomplete information may lead to visa refusal or denial of entry; the applicant bears the consequences.
Used only to generate, then deleted. What you enter is used only at the moment the PDF is generated and is deleted from server memory immediately afterwards — never stored in a database, never logged, no copy kept.

Prefer paper? Download the blank official form and fill it in by hand: Download blank PDF

Applicant's information

Name 姓名*

As in your current passport

Date of birth 出生日期*

MM-DD-YYYY, e.g. 03-15-1988

Nationality 国籍*

e.g. 美国

Sex 性别*

男 / 女

Passport number 护照号码*

Current passport

1. Last Chinese passport

Type 护照种类（因私/因公）*

e.g. 因私

Dispatching unit 原派出单位*

Write 无 for a private passport

Place of issue 签发地*

Check the NIA (国家移民管理局) mini-program, then fill in

Passport number 护照号码*

Check the NIA (国家移民管理局) mini-program, then fill in

Date of issue 签发日期*

Check the NIA (国家移民管理局) mini-program, then fill in

Why the passport cannot be provided 无法提供原因*

e.g. 搬家时遗失

2. Nationality and identity

Original Chinese name 原中文姓名*

Place of birth in China 中国出生地*

e.g. 广东广州

Former Chinese ID number 原身份证号*

Your former Chinese ID number

Former household registration address 原户籍地址*

Where your hukou was registered

Contact in China 国内联系人姓名*

A relative in China who can be reached

Contact's address 国内联系人地址*

That relative's address

Contact's phone 国内联系人电话*

Relative's mobile number

Contact's ID number 国内联系人身份证号*

Relative's Chinese ID number

Last departure from China 最近一次出境时间*

Check the NIA (国家移民管理局) mini-program, then fill in

Port of departure 出境口岸*

e.g. 上海浦东

Arrival in the US 来美时间*

US visa type on arrival 来美签证*

e.g. F1 / H1B

Date of US naturalization 加入美籍时间*

As shown on your naturalization certificate

Reason for naturalization 加入美籍原因*

e.g. 工作

First US passport obtained 首本美国护照时间*

Settled in the US? 是否已在美国定居*

Years in the US 居住时长（年）*

Write 无 if not settled

US address 在美居住地址*

Write 无 if not settled

Dates (two places, may be left blank)

Date, part 1

MM-DD-YYYY, e.g. 03-15-1988

Date, part 2

MM-DD-YYYY, e.g. 03-15-1988

* required. The date may be left blank and handwritten.

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