One (1) copy

CONSULATE GENERAL OF BANGLADESH, MIAMI of 02 inch X

760 NW 107th Avenue, Suite-320, Miami, FL-33172 02 inch
E-mail: mission.florida@mofa.gov.bd; Website: https://florida.mofa.gov.bd Photograph

APPLICATION FOR ENDORSEMENT OF ‘NO VISA REQUIRED’ FOR TRAVEL TO BANGLADESH

PLEASE FILL IN OR TYPE IN BLOCK LETTERS

1. Name Iqbal Bahar Latif

2. Date of Birth 24-May-1985 (e.g., 26-Mar-1971) 3. Place of Birth Bangladesh
4. Nationality at birth Bangladesh 5. Present nationality USA 6. Profession Chef
7. US Passport no. 682263525 8. Date of issue 07-Oct-2022 9. Date of expiry 06-Oct-2032
10. Sex Male Female 11. Marital status Single Married Widow/Widower Divorced
12. Name of spouse Tahmina Chowdhury Nationality: Bangladesh Other (please specify)
13. Name of father Abdul Latif Nationality: Bangladesh Other (please specify)
14. Name of mother Angurun Latif Nationality: Bangladesh Other (please specify)
15. Present address and contact details
Street 1920 N 58th Way House/Apt. City Hollywood ZIP code 33021
State Florida Cell no. 954-716-1158
16. Purpose of visit Tourism Visit relatives Other (please specify)
17. In case of reissue of NVR, please provide the following information:
a) Previous NVR issued by Bangladesh Embassy/Consulate General, Washington DC/New York/Los Angeles/Miami
Others (please specify)
b) Previous US passport no. 496894638 c) NVR seal no. d) Date of issue 04-Feb-2017
of NVR
18. DECLARATION
I declare that I have examined the information on this Signature of the applicant
form. To the best of my knowledge and belief, the (in case of a minor child,
information on this form is true, correct and complete. parents may sign on behalf)

19. a) Money Order/Bank Draft no. b) Issued by: c) Amount in US$: 50.00

FOR OFFICIAL USE ONLY (Do not write below this line)

Receipt no: _____________________________________ Date: ___________________ Amount (US$): 50.00

Mode of service: Mail-In Walk-In
Received by: _____________________________________ Processed by: ____________________________________
Issue no.: NVR/2022/________________________
Comments:

Signature of the issuing authority