Sayef Amin 01924122222/04475122222

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Z_¨ cwieZ©b/ms‡kvab Av‡e`b dig
Information Alteration/Correction Application Form
G digwU †KejgvÎ †gqv` DËx©Y nqwb, Giƒc cvm‡cv‡U© cÖ`wk©Z Z_¨ cwieZ©b/gy`ªYRwbZ fzj ms‡kvab
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This form will be used only to change shown information/rectify printing errors of the valid passport.
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Av‡e`‡bi mg_©‡b Dchy³ cÖgvYvw` mshy³ Kiæb|
Instruction : Please fill up the form, in ENGLISH (CAPITAL LETTERS) and attach relevant papers in favour of your
application.
Av‡e`bKvixi bvg (evsjvq)
Name of Applicant (In Bangla)
Av‡e`bKvixi bvg (Bs‡iwR‡Z)
Name of Applicant (in English)
PvwnZ ms‡kvab Required Correction
cvm‡cv‡U© eZ©gv‡b cÖ`wk©Z Z_¨
Information presently shown in the passport
cwiewZ©Z/ms‡kvwaZ Z_¨
Changed/Corrected nformation
- 1 -Iftee
AvÂwjK cvm‡cvU© Awdm/wgk‡bi bvg Name of Regional Passport
Office/Mission
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Payment of Fees
wdÕi cwigvY ($/US$)
Amount of Fee ($/US$)
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Bank/Mission
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Branch
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Receipt No.
ZvwiL
Date
M„nxZ cvm‡cv‡U©i Z_¨
Received Passport’s Details
cvm‡cvU© b¤^i Passport No. Bmy¨i ¯’vb I ZvwiL
Place & Date of Issue
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cvm‡cvU© weZi‡Yi cÖK„wZ
Type of delivery
mvaviY Riæix
Regular Express

2. ZvwiL
Date
Av‡e`bKvixi/Awffve‡Ki (Av‡e`bKvix cÖvßeq¯‹
n‡j) ¯^v¶i
Applicant’s/Guardian’s (if the applicant is a minor) Signature
- 2 -Iftee

3. mshyw³mg~n Enclosures
1. 6.
2. 7.
3. 8.
4. 9.
5. 10.
- 3 -Iftee
1. Z_¨ msMÖnKvix (Acv‡iUi) Gi
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2. Av‡e`b MÖnYKvix Awdmv‡ii
bvg
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3. cvm‡cvU©
Bmy¨/Aby‡gv`bKvix Kg©KZ©vi
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Awd‡mi e¨env‡ii Rb¨ For Official Use