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 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 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 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 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 Bangladesh Embassy, Washington D.C. * 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 hé š²na J e N llaä pwœ² ñ abé (Personal & Citizenship Details) 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) Lhmj œ 15 hvp ll e Q AfË çhuú A hcel l l r œ Ef l š² R hàu fë u Se z 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
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 Name of the Office Date of Retirement 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 S a u f lquf œl ew x National Identification Number Or Abh 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 18z Type of Citizenship hh qlp œ AeÉ eé, E õm Ll e Put ( ) in appropriate box by marriage Others, please specify ~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 f a -2
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 22z* Sl l fë u S e k N k Nl SeÉ hé š²l hhlz x (Emergency contact person s details) cn g e/gé eðl C- jcm WL e Country Phone/Fax Number e-mail Address e j x Name WL e x Address Vill/House (in Bangladesh) A hcel l l p b pçflñ x Relationship with the applicant Road/Block/Sector PS PO: District: g e/gé eðl Phone/Fax Number C- jcm WL e 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 (fë k SÉ r œ) (Copy of TIN Certificate) f XHp/Ahp ll a l Ml fêj efœ (fë k SÉ r œ) (PDS/Proof of Retirement Date) 25z* f p f VÑl SeÉ gp Sj pwœ ¹ abé hm ( k abé m fë k SÉ q h) x Payment Information 1z 2z 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 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 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 jªaé 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 AwN L l e j (Declaration) 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) f a -3
No need to fill-up this page by the Applicant in abroad 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 pjè M A hcef œ ü rl / VfpC fëc e L l Rez paé uel l l A h pl WL e x f p f VÑ/S a u f lqu fœ ew V m g e eðl (k c b L) paé uel l l e j J ü rl a lm x (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 eu p 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 CpÉ L 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 h 1z 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 e f p f VÑl SeÉ 02 (c C) L f f lzlªa f p f VÑ glj c Mm Ll a q h z 2z 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 ue Ll a q hz 3z 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 fz 4z 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±l L 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 z 5z fë k SÉ r œ fë p L S J (GO)/ He J p (NOC) c Mm Ll a q h z 6z 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 z 7z 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 ( kje X 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 e 1 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 2z 3z abé pwnëql l (Af lvl) Hl e j, BC X J ü rl A hce NÊqeL l A gp ll e j, BC X J ü rl f p f VÑ CpÉ Ae j cel l LjÑLaÑ l e j, BC X J ü rl 4z Cp ÉL«a f p f VÑ eðlx f p f VÑ halel l A gp ll e j, BC X J ü rl 5z A hcel l l f p f VÑ fê çl ü rl J a lm f a -4
Important information on Re-issue / Renew of an existing MRP (Machine Readable Passport) 1. If you do not wish to change your photograph / signature: you may not need to visit the Embassy physically. Please fill in an MRP application form (in PDF format, without barcode) and send it to the Embassy by postal mail along with the following (requirements): (a) One copy of recent photograph (size 55x45mm); (b) Photocopy of the current passport with original; (c) Photo copy of 17-digit Birth Certificate or National ID Card (which mentioned in your previous MRP); (d) A money order/bank draft of US$ 110 (for Ordinary Delivery) / US$ 220 (for Express Delivery) addressed to the Embassy of Bangladesh ; (e) Proof of Occupation (if applicant is Engineer, Physician, Researcher, Teacher, Student, Driver or any special occupation). For Private Service, no proof of occupation is required; (f) Copy of Marriage Certificate (if applicant is married); (g) Proof of non-us citizen or any foreign national (Photocopy of Green Card/Permanent Resident Card or Work Permit or I-20 etc). If applicant is US citizen or any foreign national, please provide a photocopy of Dual National Certificate. 2. If you want to change your photograph/signature in your re-issued passport, please contact the Embassy over phone to set an appointment; and follow the procedure as you would do during obtaining a new MRP. You may also visit one of our mobile MRP enrolment camp when it comes to your area. Please see the above-mentioned schedule, if any. For more information, please call us or keep an eye on our website. 3. If a machine readable passport was issued when the holder was a minor due to which biometric information was not recorded, and now the holder has attained 15 years of age, the holder needs to visit the Embassy or a mobile enrolment facility. In this case, please follow the procedure of obtaining of a new MRP as mentioned in 2. above. Mailing service: A self-addressed prepaid envelope for return mail service preferably USPS Certified with tracking number /Express Mail Flat Rate (from US Post Office) / UPS or FedEx Prepaid label by the applicant. Your passport will be sent to you once it is received from Dhaka. The return envelope is not required if the applicant wishes to collect the MRP (Passport) from the Embassy physically. Processing time for MRP: Application and requirements are received at the counter between 10:00 a.m. 1:00 p.m., Monday to Friday, except holidays. Delivery time is from 3:30 5:00 p.m. Please note that the Bangladesh Embassy needs at least 45 to 60 days (60-days for Ordinary Delivery / 45-days for Express Delivery) to process the MRP application. i. Please check the spelling and accuracy of the data that you have provided while filling in your application form since these will be reflected in your passport and fulfill all requirements to avoid any delay in processing; ii. Any misrepresentation of facts may lead to cancellation of MRP at any time.