USA Embassy Application Information

 Applicant Information:

 Applicant Surname: MEDHA

 Applicant Given Name: MAISHA FARJANA

 Have you ever been known by other name: NO

 Passport Number: A03672762 new passport

 Date of Birth: 19 FEB 2000

 Contact Email: maishamedha121@gmail.com

 What is your Gender: FEMALE

 What is your Relationship Status: UNMARRIED

 Country of Nationality: BANGLADESH

 Country of Birth: BANGLADESH

 Place of Birth: KURIGRAM

 Do you have a valid national identity card: YES

 National ID card number: 4215087166

 Provide your telephone number: 01764837300

 Issuing authority: Government of the People's Republic of Bangladesh

 Issue Date: 19 MAY 2021

  Present Address: HINGONRAY,HATIRPAR,HOSPITAL PARA, KURIGHRAM
Postcode: 5600

 Permanent Address: HOSPITALPARA, KURIGHRAM Postcode: 5600

Passport Details:

 Passport number: A03672762

 Issue date: 14 august 2022
 Expiry date: 23 august 2027

Spouse Details: (If Applicable)

 Name:
 Date of Birth:
 Passport Number:
 Passport Issue Date:
 Passport Expiry Date:
 Address:

School/College/University Information:
1. Secondary School Certificate Institution Name: Kurigram Government Girls High
School
Start Date:
End Date:May 11, 2016
Phone Number:
GPA: 4.28
Institution Address with Postcode:
2. Higher secondary Certificate Institution Name: Kurigram Government Girls High School
Start Date:
End Date:July 19, 2018
Phone Number:
GPA: 4.25
Institution Address with Postcode:
 3. University Name: Xi'an University of Finance and Economics
Start Date:
End Date:
CGPA:
Phone Number: +86 29 8525 2583
Institution Address with Postcode:  64 Xiaozhai E Rd, Yanta District, Xi'An, Shaanxi,
China, 710064

Do you have a social media presence? FACEBOOK

Social Media Provider/Platform (1):
https://www.facebook.com/profile.php?id=100028826469942
Social Media Identifier:

Social Media Provider/Platform (2): INSTAGRAM

https://instagram.com/mayeshafarzan?utm_medium=copy_link
Social Media Identifier:

Social Media Provider/Platform (3): LINKEDIN

Social Media Identifier:

Social Media Provider/Platform (4): TWITTER

Social Media Identifier:

Parent Details(Student):

FATHER
Given names: MIZANUR RAHMAN
Family name: MIZAN

Date of birth: 14 JAN 1967

Country of nationality: BANGLADESH

MOTHER
Given names: MAHABUBA AKHTER
Family name: JAHAN

Date of birth: 09 SEP 1968

Country of nationality: BANGLADESH

Other Relatives Information:

1. Family Name: ABSAN SHARIAR
Given Name: TAWFIQ
Address: GAZIPUR, DHAKA
Phone Number: +8801680998960
Email: tawfiqabsan@yahoo.com
2. Family Name: ARIYAN
Given Name: MAHMUD
Address: MIRPUR, DHAKA
Phone Number: +8801614445679
Email: ariyanmahmud15738@gmail.com

Have you traveled to any countries/regions within the last five years? (Please mention country
name)
Answer: CHINA 2 times INDIA for medical purpose