ffff fff ffdd dd MTCN NO#: 729-842-3178
SENDER'S NAME: Mr. Holly Waldon
COUNTRY SEND: United Arab Emirates (UAE)
AMOUNT TO PICK UP NOW: USD$5,000.00
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MTCN NO#: 492-016-5927
SENDER'S NAME: Mr. Abdulrazzaq Abdulkarim Al Zarooni
COUNTRY SEND: United Arab Emirates (UAE)
AMOUNT TO PICK UP NOW: USD$5,000.00
================================================MTCN NO#: 729-842-3178
SENDER'S NAME: Mr. Holly Waldon
COUNTRY SEND: United Arab Emirates (UAE)
AMOUNT TO PICK UP NOW: USD$5,000.00
-----------------------------------------------------------------------------------------------------
MTCN NO#: 492-016-5927
SENDER'S NAME: Mr. Abdulrazzaq Abdulkarim Al Zarooni
COUNTRY SEND: United Arab Emirates (UAE)
AMOUNT TO PICK UP NOW: USD$5,000.00
================================================MTCN NO#: 729-842-3178
SENDER'S NAME: Mr. Holly Waldon
COUNTRY SEND: United Arab Emirates (UAE)
AMOUNT TO PICK UP NOW: USD$5,000.00
-----------------------------------------------------------------------------------------------------
MTCN NO#: 492-016-5927
SENDER'S NAME: Mr. Abdulrazzaq Abdulkarim Al Zarooni
COUNTRY SEND: United Arab Emirates (UAE)
AMOUNT TO PICK UP NOW: USD$5,000.00
================================================
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1. f¡a¡-1
NZfÊS¡a¿»£ h¡wm¡−cn plL¡l
h¢ql¡Nje J f¡p−f¡VÑ A¢dcçl
−j¢ne ¢l−Xhm f¡p−f¡VÑ A¡−hce glj
Machine Readable Passport Application Form
• A¡−hce fœ¢V f¨lZ Ll¡l f¨−hÑ Ae¤NÊqf§hÑL −no fªù¡u h¢ZÑa p¡d¡le ¢e−cÑne¡pj§q paLÑa¡l p¢qa f¡W Ll²ez
Please read carefully the General Instructions at the last page before filling the form.
• a¡lL¡ (*) ¢Q¢q²a œ²¢jL ew …−m¡ AhnÉ f¨lZ£uz
Serial numbers marked with star (*) marks must be filled in.
• œ²¢jL ew 1 hÉa£a AeÉ¡eÉ œ²¢jL Cw−lS£−a (Capital Letters) f¨lZ£u z
Except serial number 1, all other serials must be filled in English (Capital Letters).
* B’¢mL f¡p−f¡VÑ A¢gp/h¡wm¡−cn ¢jne x * A¡−hc−el fÊL«¢a x ea¤e f§ex fËc¡e
Name of RPO / Bangladesh Mission Application type New Reissue
* A¡−hceL«a f¡p−f¡−VÑl fÊL«¢a x p¡d¡le A¢g¢pu¡m L¤V¯e¢aL
Type of passport applied for Ordinary Official Diplomatic
* f¡p−f¡VÑ ¢hal−Zl fÊL«¢a x p¡d¡le Sl¦l£
Type of delivery Regular Express
1z A¡−hceL¡l£l e¡j (h¡wm¡u) x ________________________________________________________________
Name of Applicant (in Bengali)
2z* A¡−hceL¡l£l e¡j x _______________________________________________________________________
Name of Applicant
3z* B−hceL¡l£l e¡j - A¡f¢e f¡p−f¡−VÑ e¡j −ki¡−h ®cM−a Q¡e ®pi¡−h V¡Cf Ll¦e z p−hÑ¡μQ 48¢V Arl hÉhq¡l Ll¡ k¡−hz
Name of Applicant – Type as you want it to appear in your passport. Maximum 48 characters are allowed.
(e¡−jl ®no¡wn 2u Aw−n ¢mM−a q−h Hhw 1j Aw−n HL¡¢dL Awn b¡L−m fË¢a Aw−nl j¡TM¡−e 1¢V Ol n§eÉ ®l−M f§lZ Ll−a q−h z The last
part of the name should appear in second part. Keep a blank space between two parts of the name).
fÊbj Awn First Part (Given Name)
¢àa£u Awn Second Part (Surname)
4z* ¢fa¡l e¡j x _______________________________ −fn¡ x ___________________ S¡a£ua¡ x _____________
Father’s Name Profession Nationality
5z* j¡a¡l e¡j x ________________________________ −fn¡ x ___________________S¡a£ua¡ x ____________
Mother’s Name Profession Nationality
6z ð¡j£/ Ù»£-l e¡j x ________________ _______−fn¡ x ___________________ S¡a£ua¡ x ____________
(fÊ−k¡SÉ q−m) Spouse’s Name Profession Nationality
(if applicable)
7z A¢ii¡h−Ll e¡j x _____________ __________−fn¡ x ___________________ S¡a£ua¡ x ____________
(fÊ−k¡SÉ q−m) Guardian’s Name Profession Nationality
(if applicable)
A¡−hceL¡l£l HL¢V l¢Pe
55 ^ 45 ¢jx¢jx A¡L¡−ll
R¢h A¡W¡ ¢c−u m¡N¡−e¡l fl
paÉ¡ue Ll−a q−h
Affix the photograph
here and attest on the
photo
¢X.BC.¢f glj - 1 (¢he¡j¨−mÉ fÊ¡fÉ)
A¡−hceL¡l£l ¢fa¡l
HL¢V l¢Pe 30 ^ 25
¢jx¢jx A¡L¡−ll R¢h
A¡W¡ ¢c−u m¡N¡−e¡l fl
paÉ¡ue Ll−a q−h
Affix applicant’s
Father’s photograph
here and attest on the
photo
A¡−hceL¡l£l j¡a¡l
HL¢V l¢Pe 30 ^ 25
¢jx¢jx A¡L¡−ll R¢h
A¡W¡ ¢c−u m¡N¡−e¡l
fl paÉ¡ue Ll−a q−h
Affix applicant’s
Mother’s photograph
here and attest on the
photo
−Lhmj¡œ 15 hvp−ll e£−Q AfË¡çhuú
A¡−hceL¡l£l −r−œ Ef−l¡š² R¢hàu fË−u¡Se z
hÉ¢š²Na J e¡N¢lLaÄ pwœ²¡ñ abÉ (Personal & Citizenship Details)
ুআগারগাঁও পাসপপার্ট অফিস
মোাঃ আতিয়ার রহোান
2. f¡a¡-2
8z* ¯hh¡¢qL AhÙÛ¡ ( ) ¢Qq² ¢ce x A¢hh¡¢qa ¢hh¡¢qa ¢hfaÀ£L / ¢hdh¡ a¡m¡LfÊ¡f¹
Marital Status Unmarried Married Widower/Widow Divorced
Put ( ) in appropriate box
9z* −fn¡ x _____________________________________________________________________________ _
Profession
A¢g¢pu¡m f¡p−f¡−VÑl −r−œ x (In case of Official Passport)
A¢g−pl e¡j x ____________________________________________ Ahpl NÊq−el a¡¢lM x ________________
10z* SeÈÙÛ¡e (®cn J −Sm¡) x ®c−nl e¡j ___________________________ −Sm¡l e¡j ______________________
Place of Birth Country District
11z* SeÈ a¡¢lM x ¢ce j¡p hvpl
Date of Birth Day Month Year
12z* ¢mwN ( ) ¢Qq² ¢ce x f¥l¦o j¢qm¡ AeÉ¡eÉ
Gender ( ) in appropriate box Male Female Others
13z* SeÈ pecfœ ew x
Birth Identification
Number
Or Abh¡
S¡a£u f¢lQuf−œl ew x
National Identification
Number
14z ¢VA¡CHe (k¢c b¡−L) x
Tax Identification
Number (if available)
15z* EμQa¡ x −px¢jx Or C¢’ 16z* djÑ x
Height cm Abh¡ inch Religion
17z* h¡wm¡−cn£ e¡N¢lL−aÆl p§œ x S¸jp§−œ hwnp§−œ A¢ih¡pe ®cn£uLlZ p¤−œ
(¢VL ( ) ¢Qq² ¢ce) by birth by descent Migration Naturalization
Type of Citizenship ¯hh¡¢qLp§−œ AeÉ¡eÉ, E−õM Ll¦e
Put ( ) in appropriate box by marriage Others, please specify __________________ _______
18z ®~àa e¡N¢lL q−m e¡N¢lLaÆ fÊc¡eL¡l£ ®c−nl e¡j x _________________________ f¡p−f¡VÑ ew _________________
Name of the other country in case of dual citizenship Passport No.
19z* haÑj¡e ¢WL¡e¡ x (h¡wm¡−c−n A¡−hc−el ®r−œ fË−k¡SÉ) (Applicable only when applying in Bangladesh)
Present
Address NÊ¡j / h¡p¡ _____________________ ________ l¡Ù¹¡/hÓL/−pƒl _______________ ______
Village/House Road/Block /Sector
b¡e¡ ___________________________________ X¡LOl ___________________________
Police Station Post Office
−Sm¡ __________________________________ −f¡ØV®L¡X
District Post Code
®g¡e eðl C-®jCm ¢WL¡e¡
Contact Number e-mail Address
Øq¡u£ ¢WL¡e¡ J haÑj¡e ¢WL¡e¡ HLC q−m ¢VL ( )¢Qq² ¢ce
Put ( ) if Permanent Address is same as Present Address
20z* ÙÛ¡u£ ¢WL¡e¡ x NÊ¡j/h¡p¡ _______________________ ______ l¡Ù¹¡/hÓL/−pƒl________________________
Permanent Village/House Road/Block /Sector
Address b¡e¡ ___________________________________ X¡LOl ___________________________
Police Station Post Office
−Sm¡ __________________________________ −f¡ØV−L¡X _________________________
District Post Code
®g¡e eðl C-®jCm ¢WL¡e¡
Contact Number e-mail Address
- -
Name of the Office Date of Retirement
3. f¡a¡-3
21z ¯h−c¢nL ¢WL¡e¡ x (¯h−c¢nL ¢WL¡e¡ −Lhmj¡œ h¡wm¡−cn ¢jn−e A¡−hc−el ®r−œ fË−k¡SÉ)
(Applicable only when applying in Bangladesh Missions)
¢WL¡e¡
®cn ®g¡e/gÉ¡„ eðl C-®jCm ¢WL¡e¡
22z* Sl¦l£ fË−u¡S−e ®k¡N¡−k¡−Nl SeÉ hÉ¢š²l ¢hhlZ x
(Emergency contact person’s details)
e¡j x A¡−hceL¡l£l p¡−b pÇfLÑ x
Name Relationship with the applicant
¢WL¡e¡ x
Address
®g¡e/gÉ¡„ eðl C-®jCm ¢WL¡e¡
Phone/Fax Number e-mail Address
23z f§−hÑ fÊc¡eLªa f¡p−f¡VÑ eðl (fÊ−k¡SÉ q−m) x Cp¤Él ÙÛ¡e J a¡¢lM
Previous passport details (if applicable) Place and Date of Issue
f¡p−f¡VÑ f¢lhaÑ−el L¡lZ ( ) ¢Qq² ¢ce x f¢lhaÑe hÉhq¡−ll Ae¤fk¤š² −ju¡c Eš£ZÑ q¡l¡−e¡
Reason for re apply Conversion Unusable Expired Lost
Put ( ) in appropriate box
¢S¢X eðl (fÊ−k¡SÉ ®r−œ) b¡e¡l e¡j a¡¢lM
GD No. (if applicable) Name of the Police Station Date
24z A¡−hce f−œl p¡−b pwk¤š² c¢mm¡¢c x
(Enclosures attached with the application form)
S¡a£u f¢lQuf−œl g−V¡L¢f SeÈ ¢ehåe pe−cl g−V¡L¢f plL¡l£ A¡−c−nl (¢SJ) g−V¡L¢f
(Copy of National ID) (Copy of Birth RegistrationCertificate) (fË−k¡SÉ ®r−œ) (Copy of Government Order)
R¡sf−œl (HeJ¢p) L¢f ¢hcÉj¡e f¡p−f¡−VÑl g−V¡L¢f ®VL¢eLÉ¡m pe−cl g−V¡L¢f
(fË−k¡SÉ ®r−œ)(Copy of NOC) (fË−k¡SÉ ®r−œ)(Copy of Previous Passport) (fË−k¡SÉ ®r−œ)(Copy of Technical Certificates)
¢VA¡CHe pe−cl g−V¡L¢f ¢f¢XHp/Ahp®ll a¡¢l®Ml fÊj¡efœ
(fË−k¡SÉ ®r−œ) (fË−k¡SÉ ®r−œ) (PDS/Proof of Retirement Date)
(Copy of TIN Certificate)
25z* f¡p−f¡−VÑl SeÉ ¢gp Sj¡ pwœ¦¡¿¹ abÉ¡hm£ (−k abÉ…−m¡ fË−k¡SÉ q−h) x Payment Information
hÉ¡wL/h¡wm¡−cn ¢jne Sj¡Lªa ¢g Hl f¢lj¡e (V¡L¡/j¡¢LÑe Xm¡l )
Name of the Bank/Bangladesh Mission Amount deposited (US$ in case of Bangladesh Missions)
n¡M¡ l¢nc ew a¡¢lM
Branch Receipt/Transaction No. Date
1z A¡¢j nfb L−l hm¢R ®k A¡−hcef−œ fÊcš ph abÉ paÉ Hhw ®L¡e ¢jbÉ¡ abÉ ¢c−u b¡L−m A¡¢j A¡Ceax cäe£u qhz
2z A¡¢j A¡−l¡ fÊ¢a‘¡ Ll¢R A¡¢j/A¡j¡l p¿¹¡e h¡ ®f¡oÉ, ®k ®L¡e L¡l−Z Ai¡hNÊÙÛ q−u fs−m ¢h−cn ®b−L A¡j¡−L Abh¡ A¡j¡l ®f¡oÉ−L ®c−n fÊaÉ¡haÑe
Ll¡l ®r−œ k¡ha£u MlQ f¢l−n¡−d h¡dÉ b¡Lh Hhw ¢h−c−n A¡j¡l/A¡j¡l p¿¹¡e h¡ ®f¡−oÉl jªaɤ OV−m jl−c−ql f¢lhqe MlQ A¡j¡l °hd Ešl¡¢dL¡l£/A¡j¡l L¡R
®b−L A¡c¡u−k¡NÉ q−hz
a¡¢lM x _____________________ A¡−hceL¡l£l/A¢ii¡h®Ll (A¡−hceL¡l£ AfÊ¡ç huú q−m)
ü¡rl h¡ ¢VfpC (Aef−eu L¡¢m−a)
Overseas
Address
Address
Country Phone/Fax Number e-mail Address
AwN£L¡l e¡j¡ (Declaration)