mes aaah - 2 irre 9 at auf q an date Government of Nepal Ministry of Foreign Affairs, Central Passport Office r PASSPORT APPLICATION FORM Bordetess Colour Pnote Please fr each box wth one character and leave an empty box for space. Use only CAPITAL lates. tee man te mere oF Tay was] ay seTAT Napa | STH ener MPT ator eT Be FAT eiue Personal Information/=afehitc faazor 4. Surmamen * cn prt ia db 2, Given Namesiars = 3, Place of Birthranreara = 4 Nationaliyhifeae > 8, Sexifay = 1. Citizenship of Permit Norra ar HT a * 8. Date of Issue #5. wrxauennnonart Pat Fx 9, Place of Issuesanft Heat = pom ot Travel Document Nod AOA, Date of esue AoFaTa wT FATE ZA. 10B, Place af lseuelM® wat =aPT od 1. Aadress/3ra1 1A, District * 118, Municipaiy? 41, Ward No, Voor anita! « x 110. Town/vilage ‘HE, House No, anes 12, Email 18, Phone No. a 14, Next of Kin/arra weer @ae 14 faa 4A) Futisamerstt. 14, Addcose/3 146. Disticsf=a + 140, Municinaty! 14E. Weare No, Yoo ara og 14F, Tow Villa ‘Sanne “MG. House Ne, 418, Relationshipfarar * 76. Phone Nora = ewe a afer i we aoe eA em wet 17, emaveae Thumb Impression ETT BIE” Applicants Signatureitraceat @é1° Datel Veritving Officer Name & Signature: Designation: Date: FOR OFFICE USE ONLY ia Please fill n the appropriate box with an "x" mark ality ‘Application Source & Name Name Yeas Ti Revenue Receipt N ceo [J pistit [7] Mission Application Type. Regular Emergency [_] New Lost Renewal | Dae Document Type Ordinary Diplomatic offciat [_] Travel Document it aut