je Readable Passport Application Form sree crar Ovare efter etaTET one bre fe arent Refer meer ate oT aT -arefully the General Instructions at the last page before filling the form. ‘Bites ane weet oT aE ij Serial humbers marked with star (*) marks must be filled in, © wea w8he eer atte eS (Capital Letters) AE Except serial number I, all other serials must be filled in English (Capital Letters). + sre orca afore fit 1 LAGAREAQN os » ercetert ee + men Name or RPO/Bangladesh Mission “Application type Reissue + ercerage orca eres ae ‘fete ‘Type of passport applied for Ordinary Official + sre rome erg reat Zor Type ofdetivery Regulat SLE] Express afee e aMfey AGT WF (Personal & Citizenship Details) 31 errata Gates) 2 Ol; Moya Dara ‘Name of Applicant (in Bengali) 20 areata: PMD. NAZHUL HOSSATN ‘Name of Applicant or SRT ST - IR ste ae CHSICS ORES BIH OTRICA BIR Say | Cd ab GrWH AIeTE EAT MICE | Name of Applicant - Type as you want it to appear in your passport. Maximum 48 characters are allowed, rea cree 3 wee Pres AE aR RE RE Se Te AE CE ANIC 3 WTA CHEE a ATE | ‘The last'pait of the name should appear in second part. Keep a blank space between two parts of the name). ‘see Ce First Pat (Given Name) K MID] [NTATZIMJU TL ‘feetx wet Second Part (Sumame) H}O| S}S|A[ZIN 81° fromarm:_{D. KHATRAT HOSSAIN com: Govy, SEAM wtf: BANGLADESHT Father's Name Profession Nationality em sreowas KULSUM HOSSAIN cots HOUSEWIFE ender: BANGLADESHT Mother's Name Profession Nationality ements ANTIKA ALAM corns HOUSEWIFE wréwet: BANGLADESH (STATS Bt) Spouse's Name Profession ‘Nationality u ont ‘arSret: (carer <7) Guardian's Name Profession Nationality (if applicable) mer»Brae rat (V) fee fs eae ae Marital Status }|Unmarried Married Fest wires 4 ee Widower/Widow Divorced Put (7) inappropriate ait omts PRIVATE SCLVICE Profession ‘wfePrarr sre cmH 8 (In case of Official Passport) wieomats racer it Name of the Office Date of Retirement soit were (ome com): crores BANGLADESH wera aras DHAKA Place of Birth Country District soit wreree fe Sl wo SDesofBith ae [212 In, 21? | sont (29 T8TAT yer 331 feet (v7) fe fs a xfer urs ‘Gender (7) in appropriate box Male Female Others 30% EEA, Birth Identification El I Number seat wrdte towers Navona idenninesion [DTS T> I PEL TBIAA ‘Number 38 1¢ Baer : Soke CI = = ‘Number Gfevatiabe) se" Beet: ort Or ki sort fs Wom ICE IS ae ae Religion ZSCAM 20. aremtonsh ainfiecy a 2 ert hikcl ‘sfearr Ate I (Be (7) Be fa) by birth bby descent Migration /Naturalization ‘Type of Citizenship erate coor, Bot eat Put(¥) in appropriate box by marriage Others, please specify de) EADIE Re ay eR ore ATT ™ ‘Name of the other country in case of dual cit zenship Passport No. jet wears Barts (RRETICRET SCTE CHC CAT) (Applicable only when applying in Bangladesh) ‘Address pee EEO ie seyseiors — ALOCK-A pune. pki RapBekseter | me PUR, lice St Offic Pleo HAA ne Dati QC 2394 Rote Bort Contact Number e-mail Address (7 ei ert reen ters cot re Put (v) if Permanent Address is same as Present Address 20 * et Barats att] a/avott Permanent Village/House Road/Block/Sector “Address rt ——— a aie: Police Station Post Office crm coPcaTs District Post Code CANT Rata het ‘Contact Number ‘e-mail Add-essa art 381 eer ‘tin rarer seat rat mera, TTR FOC MEA CRT CATT) + (Applicable only when applying in Bangladesh Missions) Overseas Address fet: Address omts GRR PET ANE ¢ Rate Barts Country Phone/Fax Number e-mail Address eee SITE CAMICTONT wT fees Raat s ‘(Emerge ‘contact 1's details) = MsEA_ ALAC eects PSPOUTE tes. 59/6, BLOCK-A, po:-MIPPR, Ps: MERPUR, DHAKA, ‘Address cwmpenamen: OL6P2994906 — xcen tants Phone/Fax Number e-mail Address ack emarrepe rrenreia eR (ercaTeT =) ass ene raps wR so en Frvlows pasar. deals GF eppicalo) Place and Date of issue oon after aie (v/) fe fm areas TE cram BF art ‘Reason for reapply Serena elie Expired Lost Put (~) in appropriate box ‘aft awe (ee Cw) + erie amt verte: GD No. (if applicable) Name of the Police Station Date scart Ace a A 3 (Enclosures attached with the application form) Tf State somone wcbret ey aes Fee wT erent erence (fore) wedreh (Copy ot Naot 1D) (Copy fo Birt Reisraton Cente) (ecw cree) Copy of Goverment Ord) apr (ret) aft era armenia eeore Bebra rere web (206 cw (Copy fo NOC) (ewes cw) (Copy of Previous Passport) (C95 A) (Copy of Tecan Cries) Parkas are wore Preaorperereaa rican erat (ewes cra) (cas cwat (PDS Prot of Rtement Dat) (Copy of TN Ceriteat) ACT BT FRE ST AES WITS (CX VASAT CATE RA) ¢ Payment Information core/aenot fiers TRUST BANIC wipe fear oore Greyatéareney _ —S750F Name of the Bank/Bangladesh Mission ‘About deposited (USS in case of Bangladesh Missions) wnt ___CENTRAL BRANCH PAR 112456989 sete LIOR Branch Receipt/Transaction No. Date ‘weet (Declaration) ry} at se ee eH CH THT eS AS UT ET aR CTA FT wes cm etc en eT: MEAT Ke af ra ect af eat ABTA CMP, CU COTA HAT TOTS RC MPC RM Ce ATC RAT ST CMTE OM OREN PA CRA TET AG ARCOM TAT TT ee ATH ATTA MSHA AT CCRT YET WOT RATATAT Fay aT Cae Seana A TAT STE CATS TAPIA RA | Mike serra vafine :_ 2/O2/(BR srementia/afesracen (SICeHTaa cers as BM) cares at Pome (water afte)wir (Certification) ora wr © Rerracs tre ate er eT a DD exe mre are oft Fate arta nae arte ER | roast etre fort xk sincera, ADBUSLAEIO rr men at cee > * TENA ‘afr CoRFecats c*tt (Police Verification Report) AMTIAS Fare SPU FO-GND 20-az ‘ft coir et encase erare mare t ae ar ae RN CATA ee TET aw ACT Te) & eforena bywt Sere eT prirein Sfeoat TT ar efor OTE THE (er a8 6 Fer) (cheer srg Ate) (ofr ere « A) : a fact*at (General Instruction) Brae Rae Hoi aioe eR ES FAT a 2 ae, SRP, TENS ane TET a whee, comers aeHa VIHAR < were Ree A/ue am rahe RAE 9¢ (HR) CONTE FA WE AE, ¢ (HB)/S0 (TH) THRE SET, MARE (MTASTAG) OF BA AS AN @ THIEN CH ETE WaT o8 CR) BAT ERE TACT NN RT BALE AT 3 SENERTS (90 MELEE TR) SICH CHE TCA Pret METH eT af WA (cone fhe Fa) wd Re ee ET wae eI co ania rasan weet wo rem at om IeTET CRE eee Bete aor (cram Ten, RiaFing, Biker Ren) Pere wrehty 8 oc font oe CR wf eT a TERI ACE ACER. TOT eT, A cen Gre, CoE cen @ ETT, uamresutete re Sera ice, Seal eee ues © Ver Caan OE aeey crear, ere oa oe anther, comer freon mee, COMM SaMTE TO, Tae Sw cm free, ania Table rare ToT, cab rae @ erernee-reE ARTS MCAT BNETH CHUN CTE oH 6 wi ccER rd . eat cram err Fre (GO) eP (NOC) HiRe FATE RE *4 y er PR nee AICO COT SICA ARGS TM GEA “Ten ANME wHT FATE | 1 rer ir a AR ope (CUR GYM 25 OH GRREFRR/MOHAMMAD) rete rote oregon en mA (CARR rere, affine, wba, PuaRDFE Rest) aioe et once ane eC a MACHR we mo eta cwTE, etre set ToT aE BC RTS eT ON pe ATS EA CTT Fe, TUT, “AYA Hs wom rT ATCT EE FS/AARH/ Late’ Oe IR A ‘afters aaa BAT (FOR OFFICIAL USE ONLY) 3) CRT eee (Seeds) aa are, AAG 6 ET, 81 Sree ae ones ary, RIE 6 “eT 21 ce Ray sec aon ay, SG Te 81 Rage wpe RL ore Fear a era a, TRAE PE e) sncenrertts orment afar. ef * "ares att fi ¥-c4/2098-3¢, 20,00,000 31