vats ag, Ye re a GOVERNMENT OF NEPAL Ministry of Foreign Affairs, Department of Passports ePASSPORT APPLICATION FORM Personal Information/=afenata faaeor 4. Sumamelae * THAKUR 2. Given Names * AVINASH KUMAR, 3. Place of Bithaeart = (Dstrct/Country Hf Abroad) 4. Nationality/agae * Mahottari NEPAL 5. Date of irra Ta ear?Month/Oay) 6. Sexy * 5A, 80, 2002-06-27 5B, 8, | 2059-05-13 iM] Sema Yom’ wows owes exw women Xoronen/ nt 7. Gitzenship or Permit No,riaear at angst * 8. Date of Issue 8. ceatuowrwon/aft Fat cnet) * 18017604550 2076-04-28 9. Place of Issueraft ee SIT * 10 National entity No aie sires Mahottari 5460056656 1. Latest Passport or Travel Document No / AIA. Date of Issue ao/artt art far ¢ = fst eardrum organ 118. Place of lssue/arfy wat art 12. Address/ S47 2A, Province/ sta *|Madhesh 126, District *| Mahottari 22€. Rural Municipaity/Municipality | pipra Rural Municip sa ae ira * 120. Ward No, Hacd No, (07 RE. Street/Vilage | pIPARA. 112F, House No, wee/ard* a 13." Emails thakuravinash4567890@gmail.com 14. Phone No.reia # 4977 9817814377 15, Father’s Fullname / aa ATH * 16. Mother’ Full name / ara aa. * RAM MOHIT THAKUR PHULO DEVUTHAKUR 17. Contact details in case of emergency/ eft tar were wi Fear 7A, Fullnamerarae * AVINASH KUMAR THAKUR 178. Address/oa7=1 17C.Provinee/veu* | Madhesh 170, Disticufaear *) Mahottart 176. Rural Municipality/Municipaity pra Rural Municipality 7F, Ward No, 97 re mech 7 7 eer 176, Street Vilage 17H. House No, eine PIPARA wet 18, Email@¥F tMakuravinash4so7890@gmal.com 19. Phone Novis #_ O8I7814377. safe Pee ae #1 tes speci ee aed wat a aeEeR ee er sex corner see fer re ear ny, ee sree eet Fe + ct we sre Present Fre erst Ar af 1 Applicant's Signature/ signature of Guardian, incase of minor ‘Apgoinkinant Details fragaeat aly arareaat waar aferarreat aes Enrollment Center Mahottari Date/ Fafr © —_— ata Date & Time 2023-10-04 11:30 FOR OFFICE USE ONLY ~--¥ Please fil in the appropriate box with an "X" mark ee ‘opicason Type []Reguar [C] emergency ame: Li renewat C]oamages [2] tose Sian Document type [X] orinay (34 Pages) ] ordinary (66 Pases) [] temporary [] travel Document [“] Dipiomstic Jortest | Oey Lserice 864d f32c-43fb-439b-8048-d17e66e0540d 864df32c-43fb-439b-8048-d17e66e0540d