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MRP Application Form-Combined1 28-10-10
MRP Application Form-Combined1 28-10-10
AhceLll fal
HLV lPe 30 ^ 25
jxjx ALll Rh
AW cu mNel fl
paue Lla qh
AhceLll jal
HLV lPe 30 ^ 25
jxjx ALll Rh
AW cu mNel
fl paue Lla qh
Affix applicants
Fathers photograph
here and attest on the
photo
Affix applicants
Mothers photograph
here and attest on the
photo
* Ahcel fLa x
eae
fex fce
Application type
New
Reissue
pdle
Agpum
LVeaL
Ordinary
Official
Diplomatic
pdle
Sll
Regular
Express
2z*
AhceLll ej x _______________________________________________________________________
3z*
Name of Applicant
BhceLll ej - Afe fpfV ej kih cMa Qe pih VCf Lle z phQ 48V Arl hhql Ll khz
Name of Applicant Type as you want it to appear in your passport. Maximum 48 characters are allowed.
(ejl nown 2u Awn mMa qh Hhw 1j Awn HLdL Awn bLm fa Awnl jTMe 1V Ol ne lM flZ Lla qh z The last
part of the name should appear in second part. Keep a blank space between two parts of the name).
fbj Awn First Part (Given Name)
4z*
5z*
Nationality
6z
Profession
j/ -l ej x ________________
(fkS qm) Spouses Name
Profession
Nationality
Nationality
(if applicable)
7z
AiihLl ej x _____________
(fkS qm) Guardians Name
(if applicable)
fa-1
Nationality
8z*
9z*
hhqL Ah (3) Qq ce x
Ahhqa
hhqa
hfaL / hdh
amLff
Marital Status
Put (3) in appropriate box
Unmarried
Married
Widower/Widow
Divorced
fn x _____________________________________________________________________________ _
Profession
10z*
11z*
12z*
13z*
Date of Retirement
Place of Birth
Country
District
Se alM x
ce
Date of Birth
Day
jp
hvpl
Month
Year
mwN (3) Qq ce x
flo
jqm
Aee
Male
Female
Others
Se pecf ew x
Birth Identification
Number
Or Abh
Sau flQufl ew x
National Identification
Number
14z
Tax Identification
Number (if available)
15z*
17z*
EQa x
pxjx
Height
cm
hwmcn eNlLal p x
(VL (3) Qq ce)
Type of Citizenship
Put (3) in appropriate box
18z
Or
Abh
Sjp
hwnp
by birth
by descent
16z*
Religion
Aihpe
Migration
cnuLlZ p
Naturalization
hhqLp
Aee, EM Lle
by marriage
19z*
dj
inch
haje WLe x
Present
Address
Passport No.
Road/Block /Sector
Post Office
Sm __________________________________ fVLX
District
Post Code
ge el
C-jCm WLe
Contact Number
e-mail Address
20z*
u WLe x
Nj/hp _______________________
Permanent
Address
Village/House
______ l/hL/pl________________________
Road/Block /Sector
Post Office
Post Code
ge el
C-jCm WLe
Contact Number
e-mail Address
fa-2
21z
WLe
Address
22z*
cn
ge/g el
C-jCm WLe
Country
Phone/Fax Number
e-mail Address
AhceLll pb pfL x
Name
WLe x
Address
23z
24z
25z*
ge/g el
C-jCm WLe
Phone/Fax Number
e-mail Address
Cpl e J alM
flhae
Conversion
hhqll Aefk
Unusable
juc EZ
qle
Expired
Lost
SX el (fkS r)
bel ej
alM
Date
Rsfl (HeJp) Lf
(fkS r)
(Copy of TIN Certificate)
nM
lnc ew
alM
Branch
Receipt/Transaction No.
Date
AwNLl ej (Declaration)
1z
2z
Aj Al fa LlR Aj/Ajl pe h fo, k Le LlZ AihN qu fsm hcn bL AjL Abh Ajl foL cn fahae
Lll r khau MlQ flnd hd bLh Hhw hcn Ajl/Ajl pe h fol ja OVm jlcql flhqe MlQ Ajl hd EldLl/Ajl LR
bL AcukN qhz
alM x _____________________
fa-3
faue (Certification)
Ajl e J hnpja Efl hZa ab pa Hhw BhceLl
alM x _____________
(pm jql)
pWL
alM x_____________________
pWL eu
pWL e qm LlZ (hwmcn eNlL ee/pSf/ jjmde/ WLe pWL eu/ Aee LlZ) x
_____________________________
________________________
_____________________________
pfliCSw Agpll rl
2z
3z
4z
5z
fa-4