"Application Form for New Passport" - Bangladesh (English/Arabic)

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Download "Application Form for New Passport" - Bangladesh (English/Arabic)

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A
EMBASSY OF THE PEOPLE’S REPUBLIC OF BANGLADESH
Sl. No.
: ___________
ABU DHABI, UNITED ARAB EMIRATES
Dirhams
: ___________
P.O. BOX NO. 2504, Tel. 02 4465100, Fax : 02 4464733
Receiving date : __________
Delivery date : ___________
APPLICATION FORM FOR NEW PASSPORT
(ea¥ e f¡p−f¡−VÑ l SeÉ B−hce fœ)
Form should be filled in block letters.(glj Cw−l¢S hs q¡−al Ar−l f§ l Z Ll−a q−h)
(a)
4 (Four) recent passport size photographs.(4 L¢f pcÉ ®a¡m¡ f¡p−f¡VÑ p¡C−Sl R¢h )
(b)
Previous passport or travel permit.(f¤ l ¡ae f¡p−f¡VÑ h¡ VÊ ¡ −im f¡l¢jV pwk¤ J ² Ll−a q−h)
(c)
Any other document(s) as and when required by the authority.(fË − u¡Se£u AeÉ¡eÉ L¡NSfœ pwk¤ J ² Ll−a q−h)
(d)
1. Name (e¡j)
: ______________________________________________________________________
2. Name of Father / Husband (¢fa¡/ü¡j£l e¡j) : _________________________________________________________
3. Name of Mother (j¡a¡l e¡j)
: ________________________________________________________
4. Profession as per visa (¢ip¡ Ae¤ k ¡u£ −fn¡)
: ________________________________________________________
5. Place of birth (S¾j ÙÛ ¡ e)
: ________________________________________________________
6. Date of birth(S¾j a¡¢lM)
: _________________________________________________________
7. Colour of eyes : ______________Colour of hair : ____________Height : _________m._________cm. ________
(®Q¡−Ml lw)
(Q¥ − ml lw)
(EµQa¡)
(¢jx)
(−px¢jx)
8. Visible distinguishing mark (mrZ£u ¢h−no ¢Qq² -k¢c b¡−L) : _______________________________________________
9. Permanent Address In Bangladesh : (h¡wm¡−c−n ÙÛ ¡ u£ ¢WL¡e¡)
Village (NË ¡ j) : __________________________
P.O. (®f¡ØV A¢gp) : ________________________
P.S. (Ef−Sm¡) _____________________________
District (®Sm¡)
: ________________________
10. Present Address in the United Arab Emirates : (Blh B¢jl¡−a haÑ j ¡e ¢WL¡e¡)
P. O. Box No. ____________ City / Town: _______________________________ Phone: __________________
(®f¡ØV h„ ew)
(nql)
(®g¡e ew)
11. Particulars of previous passport / Travel document (f¤ l ¡ae f¡p−f¡VÑ h¡ VÊ ¡ −im f¡l¢j−Vl abÉ):
Passport No. __________________________ Date of issue: _____________________ Place of issue: ______________
(f¡p−f¡VÑ ew)
(fË c ¡−el a¡¢lM)
(fË c ¡−el ÙÛ ¡ e)
: cn hvpl ®ju¡c Eš£ZÑ qJu¡l L¡l−Z
12.
Reason for the application for a new passport
(ea¥ e f¡p−f¡−Vl SeÉ B−hc−el L¡lZx fË − k¡SÉ −r−œ ¢VL¢Qq² ¢ce)
f¡p−f¡VÑ q¡l¡−e¡/eø qJu¡l L¡l−Z
13.
Supporting documents submitted along with this application (if any): _____________________________________
(fË − k¡SÉ ®r−œ AeÉ fË j ¡e¡¢c B−hcef−œl p¡−b pwk¤ J ² Ll−a q−h)
14.
Particulars of children to be included in the passport ( size of photos : 26X25mm, 3 photographs each ) :
(−kph ®R−m/®j−ul e¡j, ¢fa¡/j¡a¡l f¡p−f¡−VÑ A¿¹ i ¨ Ñ š ² Ll−a Q¡e a¡−cl ¢hhlZ- fË − aÉ−Ll 3 L¢f 26 X 25¢j|¢j| p¡C−Sl R¢h)x
Name (e¡j)
Sex (®R−m/®j−u)
Place of birth (S−¾jl ÙÛ ¡ e)
Date of birth (S−¾jl a¡¢lM)
i. ____________________________
_______
___________________
___________________________
ii. ____________________________
_______
___________________
____________________________
I do hereby solemnly declare that I am a Bangladeshi citizen and the above information provided by me are true to the best of my
(B¢j HC j−jÑ ®O¡oZ¡ Ll¢R ®k, B¢j HLSe h¡wm¡−cn£
Knowledge. I shall be held responsible for furnishing any false statement
e¡N¢lL Hhw Ef−l fË c š abÉ Bj¡l p−hÑ ¡ µQ S¡e¡j−a p¢WLz H−r−œ ¢jbÉ¡/i¥ m abÉ fË c ¡−el pLm c¡u c¡¢uaÄ B¢j hqe Llh z)
Date (a¡¢lM) :
___________
Applicant’s signature
(B−hceL¡l£l ü¡rl)
Applicant’s signature (ej¤ e ¡ ü¡rl)
FOR OFFICIAL USE ONLY
(A¢g−pl L¡−S hÉhq¡−ll SeÉ)
Passport No. : ___________________
Date of Issue : ___________________
Date of Expiry : ___________________
Consular Officer
A
EMBASSY OF THE PEOPLE’S REPUBLIC OF BANGLADESH
Sl. No.
: ___________
ABU DHABI, UNITED ARAB EMIRATES
Dirhams
: ___________
P.O. BOX NO. 2504, Tel. 02 4465100, Fax : 02 4464733
Receiving date : __________
Delivery date : ___________
APPLICATION FORM FOR NEW PASSPORT
(ea¥ e f¡p−f¡−VÑ l SeÉ B−hce fœ)
Form should be filled in block letters.(glj Cw−l¢S hs q¡−al Ar−l f§ l Z Ll−a q−h)
(a)
4 (Four) recent passport size photographs.(4 L¢f pcÉ ®a¡m¡ f¡p−f¡VÑ p¡C−Sl R¢h )
(b)
Previous passport or travel permit.(f¤ l ¡ae f¡p−f¡VÑ h¡ VÊ ¡ −im f¡l¢jV pwk¤ J ² Ll−a q−h)
(c)
Any other document(s) as and when required by the authority.(fË − u¡Se£u AeÉ¡eÉ L¡NSfœ pwk¤ J ² Ll−a q−h)
(d)
1. Name (e¡j)
: ______________________________________________________________________
2. Name of Father / Husband (¢fa¡/ü¡j£l e¡j) : _________________________________________________________
3. Name of Mother (j¡a¡l e¡j)
: ________________________________________________________
4. Profession as per visa (¢ip¡ Ae¤ k ¡u£ −fn¡)
: ________________________________________________________
5. Place of birth (S¾j ÙÛ ¡ e)
: ________________________________________________________
6. Date of birth(S¾j a¡¢lM)
: _________________________________________________________
7. Colour of eyes : ______________Colour of hair : ____________Height : _________m._________cm. ________
(®Q¡−Ml lw)
(Q¥ − ml lw)
(EµQa¡)
(¢jx)
(−px¢jx)
8. Visible distinguishing mark (mrZ£u ¢h−no ¢Qq² -k¢c b¡−L) : _______________________________________________
9. Permanent Address In Bangladesh : (h¡wm¡−c−n ÙÛ ¡ u£ ¢WL¡e¡)
Village (NË ¡ j) : __________________________
P.O. (®f¡ØV A¢gp) : ________________________
P.S. (Ef−Sm¡) _____________________________
District (®Sm¡)
: ________________________
10. Present Address in the United Arab Emirates : (Blh B¢jl¡−a haÑ j ¡e ¢WL¡e¡)
P. O. Box No. ____________ City / Town: _______________________________ Phone: __________________
(®f¡ØV h„ ew)
(nql)
(®g¡e ew)
11. Particulars of previous passport / Travel document (f¤ l ¡ae f¡p−f¡VÑ h¡ VÊ ¡ −im f¡l¢j−Vl abÉ):
Passport No. __________________________ Date of issue: _____________________ Place of issue: ______________
(f¡p−f¡VÑ ew)
(fË c ¡−el a¡¢lM)
(fË c ¡−el ÙÛ ¡ e)
: cn hvpl ®ju¡c Eš£ZÑ qJu¡l L¡l−Z
12.
Reason for the application for a new passport
(ea¥ e f¡p−f¡−Vl SeÉ B−hc−el L¡lZx fË − k¡SÉ −r−œ ¢VL¢Qq² ¢ce)
f¡p−f¡VÑ q¡l¡−e¡/eø qJu¡l L¡l−Z
13.
Supporting documents submitted along with this application (if any): _____________________________________
(fË − k¡SÉ ®r−œ AeÉ fË j ¡e¡¢c B−hcef−œl p¡−b pwk¤ J ² Ll−a q−h)
14.
Particulars of children to be included in the passport ( size of photos : 26X25mm, 3 photographs each ) :
(−kph ®R−m/®j−ul e¡j, ¢fa¡/j¡a¡l f¡p−f¡−VÑ A¿¹ i ¨ Ñ š ² Ll−a Q¡e a¡−cl ¢hhlZ- fË − aÉ−Ll 3 L¢f 26 X 25¢j|¢j| p¡C−Sl R¢h)x
Name (e¡j)
Sex (®R−m/®j−u)
Place of birth (S−¾jl ÙÛ ¡ e)
Date of birth (S−¾jl a¡¢lM)
i. ____________________________
_______
___________________
___________________________
ii. ____________________________
_______
___________________
____________________________
I do hereby solemnly declare that I am a Bangladeshi citizen and the above information provided by me are true to the best of my
(B¢j HC j−jÑ ®O¡oZ¡ Ll¢R ®k, B¢j HLSe h¡wm¡−cn£
Knowledge. I shall be held responsible for furnishing any false statement
e¡N¢lL Hhw Ef−l fË c š abÉ Bj¡l p−hÑ ¡ µQ S¡e¡j−a p¢WLz H−r−œ ¢jbÉ¡/i¥ m abÉ fË c ¡−el pLm c¡u c¡¢uaÄ B¢j hqe Llh z)
Date (a¡¢lM) :
___________
Applicant’s signature
(B−hceL¡l£l ü¡rl)
Applicant’s signature (ej¤ e ¡ ü¡rl)
FOR OFFICIAL USE ONLY
(A¢g−pl L¡−S hÉhq¡−ll SeÉ)
Passport No. : ___________________
Date of Issue : ___________________
Date of Expiry : ___________________
Consular Officer