¢X.BC.¢f glj - 1 (¢he¡j¨−mÉ fÊ¡fÉ) A¡−hceL¡l£l HL¢V l¢Pe 55 ^ 45 ¢jx¢jx A¡L¡−ll                                           ...
8z*    ¯hh¡¢qL AhÙÛ¡ ( ) ¢Qq² ¢ce x                  A¢hh¡¢qa                  ¢hh¡¢qa              ¢hfaÀ£L / ¢hdh¡       ...
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)         Overseas              (Ap...
fËaÉue (Certification)           A¡j¡l ‘¡e J ¢hnÄ¡pj−a Ef−l h¢ZÑa abÉ paÉ Hhw B−hceL¡l£                 hvpl k¡hv A¡j¡l f¢...
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Mrp application form combined1 28-10-10


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Mrp application form combined1 28-10-10

  1. 1. ¢X.BC.¢f glj - 1 (¢he¡j¨−mÉ fÊ¡fÉ) A¡−hceL¡l£l HL¢V l¢Pe 55 ^ 45 ¢jx¢jx A¡L¡−ll A¡−hceL¡l£l ¢fa¡l A¡−hceL¡l£l j¡a¡lR¢h A¡W¡ ¢c−u m¡N¡−e¡l fl NZfÊS¡a¿»£ h¡wm¡−cn plL¡l HL¢V l¢Pe 30 ^ 25 ¢jx¢jx A¡L¡−ll R¢h HL¢V l¢Pe 30 ^ 25 ¢jx¢jx A¡L¡−ll R¢h paÉ¡ue Ll−a q−h h¢ql¡Nje J f¡p−f¡VÑ A¢dcçl A¡W¡ ¢c−u m¡N¡−e¡l fl A¡W¡ ¢c−u m¡N¡−e¡l paÉ¡ue Ll−a q−h fl paÉ¡ue Ll−a q−h Affix the photograph −j¢ne ¢l−Xhm f¡p−f¡VÑ A¡−hce glj Affix applicant’s Father’s photograph Affix applicant’s Mother’s photographhere and attest on the photo Machine Readable Passport Application Form here and attest on the photo 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 • 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 hÉ¢š²Na J e¡N¢lLaÄ pwœ²¡ñ abÉ (Personal & Citizenship Details) 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) f¡a¡-1
  2. 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 box9z* −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 ________________ Name of the Office Date of Retirement10z* SeÈÙÛ¡e (®cn J −Sm¡) x ®c−nl e¡j ___________________________ −Sm¡l e¡j ______________________ Place of Birth Country District11z* SeÈ a¡¢lM x ¢ce j¡p hvpl Date of Birth Day Month Year12z* ¢mwN ( ) ¢Qq² ¢ce x f¥l¦o j¢qm¡ AeÉ¡eÉ Gender ( ) in appropriate box Male Female Others13z* SeÈ pecfœ ew x Birth Identification Number Or Abh¡ S¡a£u f¢lQuf−œl ew x National Identification Number14z ¢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 Religion17z* 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 Address20z* 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 f¡a¡-2
  3. 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) Overseas (Applicable only when applying in Bangladesh Missions) Address ¢WL¡e¡ Address ®cn ®g¡e/gÉ¡„ eðl C-®jCm ¢WL¡e¡ Country Phone/Fax Number e-mail Address22z* 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 Address23z 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 Date24z 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 AwN£L¡l e¡j¡ (Declaration)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 qhz2z 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¡haÑeLl¡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−hza¡¢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) f¡a¡-3
  4. 4. fËaÉue (Certification) A¡j¡l ‘¡e J ¢hnÄ¡pj−a Ef−l h¢ZÑa abÉ paÉ Hhw B−hceL¡l£ hvpl k¡hv A¡j¡l f¢l¢Qaz ¢a¢e A¡j¡l pjȤ−M A¡−hcef−œ ü¡rl /¢VfpC fËc¡e L−l−RezpaÉ¡ueL¡l£l A¡h¡¢pL ¢WL¡e¡ x paÉ¡ueL¡l£l e¡j J ü¡rlf¡p−f¡VÑ/S¡a£u f¢lQu fœ ew a¡¢lM x _____________−V¢m−g¡e eðl (k¢c b¡−L) (p£m ®j¡ql) f¤¢mn ®i¢l¢g−Lne ¢l−f¡VÑ(Police Verification Report)f¤¢mn ®i¢l¢g−Lne eðl x _______________________________________________ a¡¢lM x_____________________A¡−hceL¡l£l a−bÉl paÉa¡ k¡Q¡C x p¢WL p¢WL eup¢WL e¡ q−m L¡lZ (h¡wm¡−cn£ e¡N¢lL ee/p¡S¡fË¡ç/ j¡jm¡d£e/ ¢WL¡e¡ p¢WL eu/ AeÉ¡eÉ L¡lZ) x_____________________________ ________________________ _____________________________ fË¢a−hce CpɤL¡l£ A¢gp¡−ll ü¡rl p¤f¡li¡C¢Sw A¢gp¡−ll ü¡rl fË¢a−hce fÊ¢aü¡rlL¡l£ A¢gp¡−ll ü¡rl (f¤¢mn BC¢X J p£m) (f¤¢mn BC¢X J p£m) (f¤¢mn BC¢X J p£m) ¢e−cÑne¡ (General Instruction) A¡−hceL¡l£−L ¢ejÀ¢m¢Ma c¢mm¡¢c B−hcef−œ AhnÉC pwk¤š² Ll−a q−h1z plL¡l£, A¡d¡plL¡l£, ü¡ušn¡¢oa J l¡øË¡uaÄ pwÙÛ¡l ÙÛ¡u£ LjÑLaÑ¡/LjÑL¡l£, AhplfË¡ç plL¡l£ Q¡L¤l£S£¢h J a¡−cl ¢eiÑln£m Ù»£/ü¡j£ Hhw plL¡l£Q¡L¤l£S£¢hl 15 (f−el) hvp−ll Lj hu−pl p¿¹¡e, 5 (fy¡Q)/10 (cn) hvp−ll A¢aœ¦¡¿¹, pjfÑeLªa (p¡−lä¡lX) ®cl SeÉ HL¢V glj J AeÉ¡eÉ−cl ®r−œ ea¤ef¡p−f¡−VÑl SeÉ 02 (c¤C) L¢f f§lZLªa f¡p−f¡VÑ glj c¡¢Mm Ll−a q−h z2z AfË¡çhuú (15 hR−ll Lj) A¡−hceL¡l£l −r−®œ A¡−hceL¡l£l ¢fa¡ J j¡a¡l HL¢V L−l l¢Pe R¢h (30 ^ 25 ¢jx¢jx) R¢h A¡W¡ ¢c−u m¡N¡−e¡l fl paÉ¡ueLl−a q−hz3z S¡a£u f¢lQufœ Abh¡ SeÈ ¢ehåe pec Hhw fË−k¡SÉ ®r−œ fË¡p¢‰L ®VL¢eLÉ¡m pecpj§−ql (−kje X¡š²¡l, C¢”¢eu¡l, XË¡Ci¡l CaÉ¡¢c) paÉ¡¢ua g−V¡L¢fz4z −k pLm hÉ¢š²NZ f¡p−f¡−VÑl A¡−hcefœ J R¢h fËaÉ¡ue J paÉ¡ue Ll−a f¡l−he- pwpc pcpÉ, ¢p¢V L−fÑ¡−ln−el ®jul, ®Xf¤¢V ®jul J L¡E¢¾pmlNZ,®N−S−VX LjÑLaÑ¡, f¡h¢mL ¢hnÄ¢hcÉ¡m−ul ¢nrL, Ef−Sm¡ f¢lo−cl ®Qu¡ljÉ¡e J i¡Cp ®Qu¡ljÉ¡e, CE¢eue f¢lo−cl ®Qu¡ljÉ¡e, ®f±lpi¡l ®jul J ®f±lL¡E¢¾pmlNZ, ®hplL¡l£ ¢hnÄ¢hcÉ¡m−ul AdÉ¡fL, −hplL¡l£ L−m−Sl AdÉr, −hplL¡l£ EμQ ¢hcÉ¡m−ul fËd¡e ¢nrL, S¡a£u °c¢eL f¢œL¡l pÇf¡cL, ®e¡V¡l£f¡h¢mL J A¡d¡plL¡l£/ü¡ušn¡¢pa/l¡øËu¡š pwÙÛ¡l S¡a£u ®hae ®ú−ml 7j J ac¤dÄÑ ®NË−Xl LjÑLaÑ¡NZ z5z fË−k¡SÉ ®r−œ fË¡p¢‰L ¢S J (GO)/ He J ¢p (NOC) c¡¢Mm Ll−a q−h z6z L§V¯e¢aL f¡p−f¡VÑ m¡−il ®k¡NÉ A¡−hceL¡l£NZ−L f§lZLªa glj J pwk¤¢š²pj¤q fll¡øË j¿»Z¡m−u Sj¡ ¢c−a q−h z7z e¡−jl pw¢rçl©−fl f¢lh−aÑ f§ZÑl©−f ( ®kje-−j¡x/MD. Hl ÙÛ−m ®j¡q¡jÈc/MOHAMMAD) ¢mM¡ h¡“e£u z ¢nr¡Na h¡ Q¡L¤l£p¤−œ fË¡ç fch£pj§q (−kjeX¡š¦¡l, C¢”¢eu¡l, Xƒl, ¢fHCQ¢X CaÉ¡¢c) e¡−jl Awn ¢q−ph f¢lN¢Za q−h e¡ z gl−jl œ¦¢jL ew 3 f§l−Zl ®r−œ, HL¡¢dL Awn b¡L−m fË¢a Aw−nl j¡TM¡−e1¢V Ol n§eÉ ®l−M f§lZ Ll−a q−h z A¡−hceL¡l£l ¢fa¡, j¡a¡, ü¡j£/Ù»£ jªa q−mJ, a¡l/a¡−cl e¡−jl f§−hÑ "jªa/jlýj/Late ®mM¡ k¡−h e¡ z A¢g−pl hÉhq¡−ll SeÉ (FOR OFFICIAL USE ONLY)1z abÉ pwNËqL¡l£ (Af¡−lVl) Hl e¡j, BC¢X J ü¡rl2z A¡−hce NÊqeL¡l£ A¢gp¡−ll e¡j, BC¢X J ü¡rl3z f¡p−f¡VÑ Cpɤ Ae¤−j¡ceL¡l£ LjÑLaÑ¡l e¡j, BC¢X J ü¡rl4z Cp¤ÉL«a f¡p−f¡VÑ eðlx f¡p−f¡VÑ ¢haleL¡l£ A¢gp¡−ll e¡j, BC¢X J ü¡rl5z A¡−hceL¡l£l f¡p−f¡VÑ fÊ¡¢çl ü¡rl J a¡¢lM f¡a¡-4