REQUEST FOR REPORT OF BIRTH ABROAD
 
INSTRUCTIONS
  1. Print and complete this form (including signature).
  2. Print and complete the Consular Vital Record Search Request Form (including signature).
  3. Make a copy of your driver's license or your government-issued identification card. (When making a copy of your ID, enlarge and lighten it to aid identification.)
  4. Send ALL documents (this one, the search request form and your photocopied ID) to VitalChek Network, Inc., P O Box 1703, Brentwood, TN 37024-1703. (Express courier is recommended for expedited service and tracking.)
PURCHASER INFORMATION
Certificate Holder's name at Birth: ___________________________________________
Daytime Telephone: ___________ Email Address: _________________________
I authorize VitalChek Network, Inc. to obtain a copy of my record of birth abroad for delivery to me.
Signature: ______________________________________________

ORDER INFORMATION
Certificate of Record of Birth (DS-1350) Fees are per person and multiple copies are available.
State Department Certificate Fee $30.00
Shipping & Handling Fee
Including Express Courier Service For Domestic or International Delivery		 $63.85
Additional Copies ($20 each) __________
Total __________This is the total amount to be charged to your credit card. Please initial here ___________
(REQUIRED)
PAYMENT INFORMATION
Method of payment: ☐ Visa ☐ MasterCard ☐ Amex ☐ Discover
Credit Card Number ________________________________ Expiration Date _________
 
NOTE TO CONSUMERS
  • ALL REQUESTS MUST BE NOTARIZED BY A CERTIFIED NOTARY AND INCLUDE A PHOTOCOPY OF A VALID PHOTO IDENTIFICATION.
  • All sales are final.
  • Additional information may be required by the State Department for the fulfillment of this order.
  • Form FS-240 and the form for Amending Correcting Consular Report of Birth each have additional information requirements. Please contact VitalChek directly at 1.866.550.1850 to order either of these items.
  • Forms must bear the authentic signature of the applicant or legal guardian.
  • Neither Post Office Boxes, APO, nor FPO addresses are acceptable for delivery address.
  • A signature will be required at delivery.
  • VitalChek Network, Inc. is not responsible for delays in processing due to inaccurate or incomplete applications, declined payments, issues surrounding proof of identity, or third party delays.
  • Request volume and workload of State Department personnel may affect order processing time.