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1 F glj - 1 ( he j m f f ). A hceL l l HL V l Pe 55 ^ 45 jx jx A L ll A hceL l l fa l A hceL l l j a l R h A W c u m N e l fl NZf S a . a h wm cn plL l HL V l Pe 30 ^ 25. jx jx A L ll R h HL V l Pe 30 ^ 25. jx jx A L ll R h pa ue Ll a q h h ql Nje J f p f V A dc l A W c u m N e l fl A W c u m N e l pa ue Ll a q h fl pa ue Ll a q h Affix the photograph j ne l Xhm f p f V A hce glj Affix applicant's Father's photograph Affix applicant's Mother's photograph here and attest on the photo Machine Readable Passport Application Form here and attest on the photo here and attest on the photo Lhmj 15 hvp ll e Q Af hu . A hceL l l r Ef l R h u f u Se z A hce f V f lZ Ll l f h Ae N qf h hL.

2 No f u h Z a p d le e c ne pj q paL a l p qa f W Ll ez Please read carefully the General Instructions at the last page before filling the form. a lL (*) Q q a jL ew m Ahn f lZ uz Z uz Serial numbers marked with star (*) marks must be filled in. jL. jL ew 1 h a a Ae e jL Cw lS a (Capital Letters) f lZ u z Except serial number 1, all other serials must be filled in English (Capital Letters). * B' mL f p f V A gp/h wm cn jne x * A hc el f L a x ea e f ex f c e Name of RPO / Bangladesh Mission Application type New Reissue * A hceL a f p f V l f L a x p d le A g pu m L V e aL. Type of passport applied for Ordinary Official Diplomatic * f p f V hal Zl f L a x p d le Sl l.

3 Type of delivery Regular Express h Na J e N lLa pw ab (Personal & Citizenship Details)). 1z A hceL l l e j (h wm u) x _____. Name of Applicant (in Bengali). 2z* A hceL l l e j x _____. Name of Applicant 3z* B hceL l l e j - A f e f p f V e j ki h cM a Q e pi h V Cf Ll e z p h Q 48 V Arl h hq l Ll k hz Name of Applicant Type as you want it to appear in your passport. Maximum 48 characters are allowed. (e jl no wn 2u Aw n mM a q h Hhw 1j Aw n HL dL Awn b L m f a Aw nl j TM e 1 V Ol n e l M f lZ Ll a q h z The last part of the name should appear in second part. Keep a blank space between two parts of the name). f bj Awn First Part (Given Name).

4 A u Awn Second Part (Surname). 4z* fa l e j x _____ fn x _____ S a ua x _____. Father's Name Profession Nationality 5z* j a l e j x _____ fn x _____S a ua x _____. Mother's Name Profession Nationality 6z j / -l e j x _____ _____ fn x _____ S a ua x _____. (f k S q m) Spouse's Name Profession Nationality (if applicable). 7z A ii h Ll e j x _____ _____ fn x _____ S a ua x _____. (f k S q m) Guardian's Name Profession Nationality (if applicable). f a -1. 8z* hh qL Ah ( ) Qq ce x A hh qa hh qa hfa L / hdh a m Lf f . Marital Status Unmarried Married Widower/Widow Divorced Put ( ) in appropriate box 9z* fn x _____ _. Profession A g pu m f p f V l r x (In case of Official Passport).

5 A g pl e j x _____ Ahpl N q el a lM x _____. Name of the Office Date of Retirement 10z* Se e ( cn J Sm ) x c nl e j _____ Sm l e j _____. Place of Birth Country District 11z* Se a lM x ce j p hvpl Date of Birth Day Month Year 12z* mwN ( ) Qq ce x f l o j qm Ae e . Gender ( ) in appropriate box Male Female Others 13z* Se pecf ew x Birth Identification Number Or Abh . S a u f lQuf l ew x National Identification Number 14z VA CHe (k c b L) x - - Tax Identification Number (if available). 15z* E Qa x px jx Or C ' 16z* dj x . Height cm Abh inch Religion 17z* h wm cn e N lL a l p x S jp hwnp A ih pe cn uLlZ p . ( VL ( ) Qq ce) by birth by descent Migration Naturalization Type of Citizenship hh qLp Ae e , E M Ll e Put ( ) in appropriate box by marriage Others, please specify _____ _____.

6 18z ~ a e N lL q m e N lLa f c eL l c nl e j x _____ f p f V ew _____. Name of the other country in case of dual citizenship Passport No. 19z* ha j e WL e x (h wm c n A hc el r f k S ) (Applicable only when applying in Bangladesh). Present Address N j / h p _____ _____ l /h L/ p l _____ _____. Village/House Road/Block /Sector b e _____ X LOl _____. Police Station Post Office Sm _____ f V L X. District Post Code g e e l C- jCm WL e . Contact Number e-mail Address q u WL e J ha j e WL e HLC q m VL ( ) Qq ce Put ( ) if Permanent Address is same as Present Address 20z* u WL e x N j/h p _____ _____ l /h L/ p l_____. Permanent Village/House Road/Block /Sector Address b e _____ X LOl _____.

7 Police Station Post Office Sm _____ f V L X _____. District Post Code g e e l C- jCm WL e . Contact Number e-mail Address f a -2. 21z h c nL WL e x ( h c nL WL e Lhmj h wm cn jn e A hc el r f k S ). Overseas (Applicable only when applying in Bangladesh Missions). Address WL e . Address cn g e/g e l C- jCm WL e . Country Phone/Fax Number e-mail Address 22z* Sl l f u S e k N k Nl Se h l hhlZ x (Emergency contact person's details). e j x A hceL l l p b p fL x Name Relationship with the applicant WL e x Address g e/g e l C- jCm WL e . Phone/Fax Number e-mail Address 23z f h f c eL a f p f V e l (f k S q m) x Cp l e J a lM. Previous passport details (if applicable) Place and Date of Issue f p f V f lha el L lZ ( ) Qq ce x f lha e h hq ll Ae fk ju c E Z q l e.

8 Reason for re apply conversion Unusable Expired Lost Put ( ) in appropriate box S X e l (f k S r ) b e l e j a lM. GD No. (if applicable) Name of the Police Station Date 24z A hce f l p b pwk c mm c x (Enclosures attached with the application form). S a u f lQuf l g V L f Se eh e pe cl g V L f plL l A c nl ( SJ) g V L f (Copy of National ID) (Copy of Birth RegistrationCertificate) (f k S r ) (Copy of Government Order). R sf l (HeJ p) L f hc j e f p f V l g V L f VL eL m pe cl g V L f (f k S r )(Copy of NOC) (f k S r )(Copy of Previous Passport) (f k S r )(Copy of Technical Certificates). VA CHe pe cl g V L f f XHp/Ahp ll a l Ml f j ef.

9 (f k S r ) (f k S r ) (PDS/Proof of Retirement Date). (Copy of TIN Certificate). 25z* f p f V l Se gp Sj pw ab hm ( k ab m f k S q h) x Payment Information h wL/h wm cn jne Sj L a g Hl f lj e (V L /j L e Xm l ). Name of the Bank/Bangladesh Mission Amount deposited (US$ in case of Bangladesh Missions). n M l nc ew a lM. Branch Receipt/Transaction No. Date AwN L l e j (Declaration). ( ). 1z A j nfb L l hm R k A hcef f c ph ab pa Hhw L e jb ab c u b L m A j A Ceax c e u qhz 2z A j A l f a Ll R A j/A j l p e h f o , k L e L l Z Ai hN q u fs m h cn b L A j L Abh A j l f o L c n f a ha e Ll l r k ha u MlQ f l n d h d b Lh Hhw h c n A j l/A j l p e h f o l j a OV m jl c ql f lhqe MlQ A j l hd E l dL l /A j l L R.

10 B L A c u k N q hz a lM x _____ A hceL l l/A ii h Ll (A hceL l Af hu q m). rl h VfpC (Aef eu L m a). f a -3. f a ue (Certification). ( ). A j l e J hn pj a Ef l h Z a ab pa Hhw B hceL l hvpl k hv A j l f l Qaz a e A j l pj M A hcef rl / VfpC f c e L l Rez pa ueL l l A h pL WL e x pa ueL l l e j J rl f p f V /S a u f lQu f ew a lM x _____. V m g e e l (k c b L) (p m j ql). f mn i l g Lne l f V (Police Verification Report)). f mn i l g Lne e l x _____ a lM x_____. A hceL l l a b l pa a k Q C x p WL p WL eu eu p WL e q m L lZ (h wm cn e N lL ee/p S f / j jm d e/ WL e p WL eu/ Ae e L lZ) x _____ _____ _____. f a hce Cp L l A gp ll rl p f li C Sw A gp ll rl f a hce f a rlL l A gp ll rl (f mn BC X J p m) (f mn BC X J p m) (f mn BC X J p m).