U.S. Embassy & Consulates in Japan

Please use this form to make an appointment for loss of U.S. citizenship at U.S. Embassy Tokyo.

Full name (as shown on U.S. citizenship evidence):

All previous and/or other names used since birth:

Place of birth (city, state, country):

Date of Birth:

How U.S. citizenship was acquired:

List your current foreign citizenships and how you obtained them:

Date naturalized as a foreign citizen
(if applicable):

Precise period of your physical presence in the United States:

From:

To:

Your last address in the United States:

10.

Issue date of your current U.S. Passport:

11.

Last travel date using your U.S. Passport:

12.

Current address:

13.

Daytime phone number:

14.

Email address:

15.

Preferred dates for your interview:

Please indicate at least three preferred appointment dates. Appointments are available only on Tuesday and Thursday afternoons at 2 p.m., excluding Japanese and American holidays. Please note that we may contact you on your day time phone number for the initial consultation before the interview.