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Sl. No.

: ______________

Dirhams

: ______________

EMBASSY OF THE PEOPLE’S REPUBLIC OF BANGLADESH

Receiving date : _____________

ABU DHABI, UNITED ARAB EMIRATES

P.O. BOX NO. 2504, Tel. 02 4465100, Fax : 02 4464733

Delivery date : ______________

APPLICATION FORM FOR PP RENEWAL / ALTERATION / ENDORSEMENT

(f¡p−f¡VÑ eh¡ue/f¢lhaÑ e /H−ä¡pÑ − j¾V-Hl SeÉ B−hcefœ)

[Form should be filled in block letters (glj Cw−l¢S hs q¡−al Ar−l f§ l Z Ll−a q−h)]

1. Name (e¡j)

: _______________________________________________________________

2. Name of Father / Husband (¢fa¡/ü¡j£l e¡j) : ______________________________________

3. Passport No. ________________ Date of Issue: _______________ Place of issue :______________

(f¡p−f¡VÑ ew)

(fË c ¡−el a¡¢lM)

(fË c ¡−el ÙÛ ¡ e)

4. Profession as per visa (¢ip¡ Ae¤ k ¡u£ −fn¡) : ____________________________________________

5. 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¡)

: ________________________

6. Present Address in the United Arab Emirates : (Blh B¢jl¡−a haÑ j ¡e ¢WL¡e¡)

P. O. Box No.___________City / Town:_____________________Phone: __________________

(®f¡ØV h„ ew)

(nql)

(®g¡e ew)

7. Purpose: Renewal / alteration of name(s) / profession / date of birth / address /

Inclusion of child (per child - 26mm. X 25 mm. sized 3 photographs required)/

New photograph endorsement (3 copies of passport size photographs)

(E−ŸnÉx eh¡ue/e¡j/®fn¡/S¾j a¡¢lM/¢WL¡e¡ f¢lhaÑ e /p¿¹ ¡ e−cl A¿¹ i ¨ Ñ ¢ š²-H−r−œ fË − aÉ−Ll 3 L¢f 26 X 25¢j|¢j|

p¡C−Sl R¢h pwk¤ š ² Ll−a q−hz ¢e−Sl R¢h H−ä¡−pÑ l ®r−œ 4 L¢f f¡p−f¡VÑ p¡C−Sl R¢h fË − u¡Se)

_______________________________________________________________________________

8. Details of endorsement (H−ä¡pÑ − j¾V Hl ¢hhlZ) :

______________________________________________________________________________

9. Supporting documents / certificates etc. submitted along with this application :

(pwk¤ š ² AeÉ¡eÉ fË j ¡Z¡¢c/p¡¢VÑ ¢ g−LV CaÉ¡¢c)

_________________________________________________________________________________

I do hereby solemnly declare that I am a Bangladeshi citizen and the above information provided by me are true to the

(B¢j HC j−jÑ ®O¡oZ¡ Ll¢R ®k,

best of my Knowledge .I shall be held responsible for furnishing any false statement

B¢j HLSe h¡wm¡−cn£ e¡N¢lL Hhw Ef−l fË c š abÉ Bj¡l p−hÑ ¡ µQ S¡e¡j−a p¢WLz H−r−œ ¢jbÉ¡/i¥ m abÉ fË c ¡−el pLm

c¡u c¡¢uaÄ B¢j hqe Llh z)

Date (a¡¢lM) :

Applicant’s signature

(B−hceL¡l£l ü¡rl)

FOR OFFICIAL USE ONLY

(A¢g−pl L¡−S hÉhq¡−ll SeÉ)

No. : ___________________Date :_____________

Renewed up to : _____________________

Endorsed as

: _____________________

Consular Officer

Application Form For Pp Renewal Alteration Endorsement - Embassy Of The People'S Republic Of Bangladesh

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