Transcription of MYcÖRvZš¿x evsjv‡`k miKvi ewnivMgb I cvm‡cvU© …
1 MYc RvZ x evsjv `k miKvi ewnivMgb I cvm cvU Awa` i wiBmy /Z_ cwieZ b/ms kvab Av e`b dig Reissue/ information Alteration/Correction Application Form digwU cvm cv U i gqv` D xY , Z_ cwieZ b/gy` YRwbZ fzj ms kvab ms v wel q e e Z n e| This form will be used to reissue, to change the information /rectify the printing errors of passport. wb ` kbv t digwU Bs iwR Z (CAPITAL LETTER S) c~iY Ki b Ges AbyM nc~e K Avcbvi Av e` bi mv _ Dchy c gvYvw` mshy Ki b| Instruction : Please fill up the form in English (CAPITAL LETTER S) and attach relevant documents in favour of your application. Av e`bKvixi bvg (evsjvq) Name of Applicant (In Bangla) Av e`bKvixi bvg (Bs iwR Z) Name of Applicant (in English) PvwnZ ms kvab Expected Correction cvm cv U eZ gv b c `wk Z Z_ information on existing passport c Z vwkZ cwieZ b/ms kvab Expected Change/Correction ZvwiL Date Av e`bKvixi/Awffve Ki (Av e`bKvix Ac v eq n j) ^v i Applicant s/Guardian s (if the applicant is a minor)
2 Signature wefvMxq/ Av wjK cvm cvU Awdm/wgk bi bvg Name of Divisional/Regional Passport Office/Mission M nxZ cvm cv U i Z_ Received Passport s Details cvm cvU b ^i Passport No. Bmy i vb Place of Issue gqv` D x Y i ZvwiL Date of Expiry Bmy i ZvwiL Date of Issue cvm cvU weZi Yi c K wZ Type of delivery mvaviY Ri wi Regular Express wd c `vb ms v Z_ Payment of Fees wd i cwigvY ($/USD) Amount of Fee ($/USD) e vsK/wgk bi bvg Bank/Mission kvLv Branch iwk` bs Receipt No. ZvwiL Date