ASSISTANTANT HIGH COMMISSION FOR THE PEOPLE'S REPUBLIC OF

BANGLADESH,
MANCHESTER
Paste Applicant's
Photograph here

Cedar House (3rd Floor), 2 Fairfield Street, Manchester; M1 3GF

Tel: 0161-236 4853, Fax: 0161-236 1522
Email: bdoot.man@btconnect.com; Web site: www.bahcmanchester.org.uk

Application for Character Certificate

Incomplete Application form will not be accepted. Please fill up all of the field.
1.

Name of the Applicant

:.......................................................................................................................................
2.

Date of Birth

:............................................., Place of

Birth :..........................................................
3.

Profession

.......

:............................................, Gender:

(Female/Male) :.................................................
4.

Father's Name
:.......................................................................................................................................

5.

Mother's Name
:.......................................................................................................................................

6.

Bangladesh Passport No:............................................., Place of

Issue :...............................................................
Date of Issue

:............................................, Date of

Expiry :................................................................
7.

British Visa No

:.............................................., Type of Visa :..............................,

Valid Until :...............

8.

British Passport No (If any):..........................................................., Place of

Issue :..............................................
Date of Issue

:......................................................, Date of

Expiry :.....................................................

9.

Address in the UK
:.....................................................................................................................................
........................................................., Post Code :.................................... , Phone

No:.........................................
10.

Permanent Address in

Bangladesh: .....................................................................................................................
...............................................................................................................................................
..............................
11.

Reference In Bangladesh:

Name of the

person:........................................................................................
Relationship: ........................................,
Address:..............................................................................................
........................................................................................................., Phone
No:.................................................

12.

Reference in the UK:

Name of the

person:............................................................................................
Relationship: ........................................,
Address:...............................................................................................
........................................................................................................., Phone
No:..................................................
13.

Reasons for applying Character

Certificate :......................................................................................................
...............................................................................................................................................
.............................
14.

Are/were you involved in any criminal activities ?

Yes

No

If yes then please write the

reason/s :...................................................................................................................

15.

Are/were you involved in any anti-social activities ?

Yes

No

If yes then please write the reason

/s:...................................................................................................................
16.

Are/were you involved in any anti-state activities ? :

Yes

No

If yes then please write the

reason/s :...................................................................................................................
17.

Is/was there any case against you in any local/Bangladesh court? :

Yes

No

If yes then please write the

reason/s :...................................................................................................................
-----------------------------------------------------------------------------------------------------------------------------------------------------------Please Enclose following document/s with the Application:
A. One recent Passport size Photograph.
B. Valid Bangladeshi Passport along with photocopy of the passport ( All of the information
pages).
C. Valid British Passport (if any) along with photocopy.
I hereby declare that all the information given above are true. I will remain responsible for any
false information in this application and its consequent legal implications.

Date: ............................................

.......................................

..........................
Name (in capital): ................................................................................

Signature of

the Applicant ( as in Passport)

---------------------------------------------------------------------------------------------------------------------------------------------------------For Office Use only: