pdf

1. MYcÖRvZš¿x evsjv‡`k miKvi
ewnivMgb I cvm‡cvU© Awa`ßi
wiBmy¨/Z_¨ cwieZ©b/ms‡kvab Av‡e`b dig
Reissue/Information Alteration/Correction Application Form
digwU cvm‡cv‡U©i †gqv` DËxY©, Z_¨ cwieZ©b/gy`ªYRwbZ fzj ms‡kvab msµvšÍ wel‡q e¨eüZ n‡e|
This form will be used to reissue, to change the information/rectify the printing errors of passport.
 wb‡`©kbv t digwU Bs‡iwR‡Z (CAPITAL LETTER’S) c~iY Kiæb Ges AbyMÖnc~e©K Avcbvi Av‡e`‡bi mv‡_ Dchy³ cÖgvYvw` mshy³ Kiæb|
Instruction : Please fill up the form in English (CAPITAL LETTER’S) and attach relevant documents 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 Expected Correction
cvm‡cv‡U© eZ©gv‡b cÖ`wk©Z Z_¨
Information on existing passport
cÖZ¨vwkZ cwieZ©b/ms‡kvab
Expected Change/Correction
ZvwiL
Date
Av‡e`bKvixi/Awffve‡Ki (Av‡e`bKvix AcÖvßeq¯‹ n‡j) ¯^v¶i
Applicant’s/Guardian’s (if the applicant is a minor) Signature
wefvMxq/ AvÂwjK cvm‡cvU© Awdm/wgk‡bi bvg
Name of Divisional/Regional Passport Office/Mission
M„nxZ cvm‡cv‡U©i Z_¨
Received Passport’s Details
cvm‡cvU© b¤^i Passport No. Bmy¨i ¯’vb Place of Issue
‡gqv` DËx‡Y©i ZvwiL Date of Expiry Bmy¨i ZvwiL Date of Issue
cvm‡cvU© weZi‡Yi cÖK„wZ
Type of delivery
mvaviY Riæwi
Regular Express
wd cÖ`vb msµvšÍ Z_¨
Payment of Fees
 wdÕi cwigvY ($/USD)
Amount of Fee ($/USD)
 e¨vsK/wgk‡bi bvg
Bank/Mission
 kvLv
Branch
 iwk` bs
Receipt No.
 ZvwiL
Date