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Sl. No. : ___________ EMBASSY OF THE PEOPLE’S REPUBLIC OF BANGLADESH

Dirhams : ___________ ABU DHABI, UNITED ARAB EMIRATES
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¡−VÑl SeÉ B−hce fœ)
(a) Form should be filled in block letters.(glj Cw−l¢S hs q¡−al Ar−l f§lZ Ll−a q−h)
(b) 4 (Four) recent passport size photographs.(4 L¢f pcÉ ®a¡m¡ f¡p−f¡VÑ p¡C−Sl R¢h )
(c) Previous passport or travel permit.(f¤l¡ae f¡p−f¡VÑ h¡ VÊ¡−im f¡l¢jV pwk¤J² Ll−a q−h)
(d) Any other document(s) as and when required by the authority.(fË−u¡Se£u AeÉ¡eÉ L¡NSfœ pwk¤J² Ll−a q−h)

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 haÑj¡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) (fËc¡−el a¡¢lM) (fËc¡−el ÙÛ¡e)
12. Reason for the application for a new passport : cn hvpl ®ju¡c Eš£ZÑ qJu¡l L¡l−Z
(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 fËj¡e¡¢c B−hcef−œl p¡−b pwk¤J² 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¿¹iÑ̈š² 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
Knowledge. I shall be held responsible for furnishing any false statement (B¢j HC j−jÑ ®O¡oZ¡ Ll¢R ®k, B¢j HLSe h¡wm¡−cn£
e¡N¢lL Hhw Ef−l fËcš abÉ Bj¡l p−hÑ¡µQ S¡e¡j−a p¢WLz H−r−œ ¢jbÉ¡/i¥m abÉ fËc¡−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