68406 SERIAL NO. THE REPUBLIC OF UGANDA ‘THE UGANDA CITIZENSHIP AND IMMIGRATION CONTROL ACT 3 1999 APPLICATION FOR UGANDA TRAVEL DOCUMENT (Please read notes on this reverse before completing the form) ‘rainary mca Diplomatic File Reference No. 1. THE APPLICANT: Photograph (Facial) Sumame, Other Names. poe - DO NOT STAPLE Date of Birth. Place of Birth, . co TE BHOTO. Profession. OHA Postal Address... BACKGROUND Telephone Number. Residential Address. (foutside Uganda state nearest responsible Uganda mission) 2. CITIZEN OF UGANDA: By descent: by birth: by registration: by naturalization (Delete words which do not apply) 3. MARRIED WOMEN: Maiden names. " Husband's full names, Date and place of marriage. 4. DECLARATION |, the undersigned, hereby apply for the issue of a Uganda Passport, I declare~ 4) thatthe information given in this application is correct to the best of my knowledge and belief, ») that I have not lost that status of citizen of Uganda 6) that I have not previously applied for a travel document of any description: 4) that all previous documents granted to me have surrendered other than travel document No. Issued at, on. which is lostdestroyed now enclosed and that [ have made no other aplication for a passport since the attached was issued (Delete (c) or (d) whichever is inapplicable) «that I fully understand the legal implications of what I have stated above as such I do accept any legal consequences that may arise out of what I have stated in this form. Specimen Dat Sfenature Ta For Siar mat ie me of a aon _—5, RECOMMENDER:! certify that the applicant is personally known to me and to the best of my knowledge and beli (the facts stated on this form are correct. I am a citizen of Uganda. Full names... Profession... Address. sere PRONE Notes: 1. How to complete the form Section 1,2,4 and 5 of this form must be completed by all applicants for new passports. 2, Authentication of application ‘The application must be authenticated and sponsored in section 5 by a citizen of Uganda of some standing. 3. Photographs ‘The copies of recent photographs of the applicant must be inckade¢ with application ‘These photographs must be taken full face without a hat, veil and must not be mounted ‘The size of photographs must not be more than 3.Sem (1.5 inches) by 4.Sem (1.75 inches). ‘The photographs must be printed on normal thin photographic paper and must not be glazed on the reverse side. ‘The recomender is also required to endorse the reverse side of the one of the photographs with the words. ™L certify that this isa true likeliness of the applicant Mr/Mrs./Miss.. and his or her Signature."