Professional Documents
Culture Documents
wd' ' 35 $ IM 35
;=kajk PdhdrEmh
fuys w,jkak
%d;whtJ epoy;
glj;ij ,q;Nf
xl;lTk;
Affix the
third Photograph
here
Please follow all instructions given in page 04 and 05 before filling the application.
ldhd,hSh m%fhdackh i|yd $ mYtyf cgNahfj;jpw;F khj;jpuk; /For Office use only
APPLICATION No.
AC CODE
N
bx.%Sis NdIdfjka msru jvd;a iqiqf$ tpz;zg;gg;gbtj;ij Mq;fpyj;jpy; epug;GtNj rpwe;jJ.
1' oekg we;s .uka n,m;%fha wxlh/,g;Nghija gpuahzr; rPl;bd; ,yf;fk;
2'
mqoa., ye+kqm;a wxlh/ nrhe;j Njrpa Msilahs
Present Travel Document Number
ml;ilapd; ,yf;fk;/Personal Identity Card Number
3' jdi.u$fm<m;a k
Kjw; ngah;
Surname
4' jdi.u yer fjk;a k$Kjw;
ngah; jtph;e;j kw;iwa ngah;fs;
Maiden Name
6' ia:sr ,smskh$ epue;ju tpyhrk;
Permanent Address
7' Wmka oskh $ gpwe;j jpfjp
Date of birth
8' Wmamekak iy;slfha
Birth Certificate
wxlh$,yf;fk;
Number
ia;%slalh
khtl;lk; / District
wjdyl
11'
jdpikahdtH/Single
jdyl$ tpthfkhdtH
Married
lalido$ tpthfuj;Jr;
nra;jth; / Divorced
jekaoUq $ jhukpoe;jth;
Widowed
Nkdpapd; epwk;
Complexion
of Skin
;o l $ fWg;G / Black
l $ fUik $ Dark
;f< $ nghJepwk; $ Fair
iq $ nts;is $ White
Colour of Hair
l $ fWg;G / Black
Uqre$nghd;dpwk;$ Blond
iq $eiu $ Gray
ke;
Yes
No
Mk;
Have you obtained Citizenship of a foreign country or Dual Citizenship in Sri Lanka ?
16' Yrfha mdg
l $ fWg;G / Black
ks,a $ ePyk; $ Blue
Colour of Eyes Uqre$kz;zpwk;$ Brown
ly $ kQ;;rs; $ Yellow
fz;fspd; epwk;
,y;i
; y
whlref.a m%ldYh
uu/ Y%S ,xldf mqrjeishl= nj m%ldY lr./uu ............ ^rf ku ,shkak& mqrjeisNdjh/Y%S ,xld oa;aj
mqrjeisNdjh ,nd we;af;'*
.uka n,m;%hla" yis iy;slhla fyda ykd.ekSf iy;slhla ud i;=j fkd;snqKq nj fyda tjekakla i|yd wh fkdlrk ,o nj;a"
fuhska iy;sl lr'*
f iu. bm;a lrkq ,nk wxl ork .uka n,m;%h$yis iy;slh$ ykd.ekSf iy;slh yer g fmr ud i;=j
;snqKq ishu .uka n,m;%$yis iy;sl yd ykd.ekSf iy;sl" wj,x.= lsu i|yd Y%S ,xld .uka n,m;% ms<sn| ksis ks,Odkag uiska
Ndr we;s nj;a" g wuqKd we;s .uka ,sh,a, ud fj; ksl=;a lsfuka miq tjekakla i|yd fjk;a wh m;%hla uiska bm;a
fkdlrk ,o nj;a m%ldY lr'*
fuu wh m;%hg wuqKd we;s ,shlsh,s i;H yd ksjer tajd nj;a" i;H f;dr;=re jika lsu fyda lafIam lsu i|yd tu ,shlsh,s
jHdc f,i fjkia lsj,g yd tl;=lsj,g Ndckh fkdlrk ,o nj;a iy;sl lr'
kh :
.....................
whlref.a w;aik
whlre ms<sn| iy;slh ^f i|yd .dia;=jla wh fkdl< hq;=h&
.......................................... mx
...... jk uu
whlre jk wjqre .. ld,hla ;siafia mqoa.,slj
ykk nj;a" Tyq$weh Y%S ,xld .uka ,sh,a,la ,eug iqiq wfhla nj;a iy;sl lr'
Tyq$weh iska we;s f;dr;=re i;H nj;a" iy;sl lrk w;r"
whlre ;u iqqmqre w;aik ud bmsg oS
iy;sl lr'
.. k oS ;enQ nj o
.....................
iy;sl lrkakdf.a w;aik
ie,lsh hq;=hs :
^1& whlrejka ms<sn| iy;sl lrkakjqka iska tfia l< yelafla whlre ms<sn|j fm!oa.,sl oekSula u; muKla nj ie<lsh hq;=h'
^2& by; i|yka iy;sl lsrSu l< yelafla Y%S ,xld mmd,k fiajfha$ wOHdmk mmd,k fiajfha$bxfkare fiajfha$.Kldld fiajfha$
ie,iq fiajfha ks,Odfhla" iqiql,;a ffjoHjrfhla fyda kS;s{jrfhla fyda iudodk ksYaphldrjrfhla" ;%sO yuqodf iy fmd,Sisfha
wld,;a ks,Odrfhla hk whg muKs'
tpz;zg;gfhuhpd; cWjpAiu
ehd; ,yq;if gpui[/ ,ul;ilg; gpu[hThpik ngw;Ws;Nsd;. ehd; ............. (ehl;bd; ngaiu vOjTk;) gpui[
MFk;.* ehd; xU ,yq;ifg; gpuirnad;W cWjp$Wfpd;Nwd;.* ehd; ,t;tpz;zg;gj;jpy; nfhLj;j tpguq;fs; ehd; mwpe;j tiuapYk; ek;Gfpd;w tiuapYk;
cz;ikahditnad;Wk; rhpahditnad;Wk; cWjp$WfpdN
; wd;. ,g;nghOJ ,izf;fg;gl;Ls;s..................... Mk; ,yf;f
flTr;rl
P ;L/ mtru fhyr; rhd;wpjo;/ milahsr; rhd;wpjioj; jtpu> ,jw;F Kd;G ehd; itj;jpUe;j rfy flTr;rl
P ;Lf;fSk; mtruf; fhyr; rhd;wpjo; /
milahsr; rhd;wpjo;fSk; ,yq;iff; flTr;rl
P ;L mjpfhhpfsplk; uj;Jr;nra;a xg;gilf;fg;gl;Ls;sd vd;Wk;> ,j;Jld; ,izf;fg;gl;bUg;gJ vdf;F
toq;fg;gl;lJ Kjy; NtW tpz;zg;gk; vd;dhy; rkh;g;gpf;fg;gltpy;iynad;Wk; ,j;jhy; rhd;W mspf;fpd;Nwd;.*
my;yJ ,jw;F Kd;dh; ehd; VjhtNjhh; flTr;rl
P ;L mtrufhyr; rhd;wpjo; my;yJ milahsr; rhd;wpjio itj;jpUf;fNth my;yJ tpz;zg;gpf;fNth
,y;iynad;W ,j;jhy; rhd;W mspf;fpd;Nwd;. ,izf;fg;gl;Ls;s Gifg;glk; vdJ ,aw;ifj; Njhw;wj;ij khWNtlkpy;yhkYk; kiwf;fhkYk; njspthff;
fhz;gpff
; pdw
; njd;Wk; mg;Gifg;glk; nrd;w %d;W khjq;fSf;Fs; vLf;fg;gl;lnjd;Wk; rhd;wspff
; pdN
; wd;. ,t;tpzz
; g;gj;Jld; ,izf;fg;gl;Ls;s Mtzq;fs;
cz;ikahditnad;Wk; rhpahditnad;Wk; khw;wq;fis> jpUj;jq;fis Nkhrbfisr; nra;J cz;ikia kiwf;ftpyi
; ynad;Wk; jphpGgLj;jtpyi
; ynad;Wk;
rhd;W mspf;fpd;Nwd;.
jpfjp :
* nghUj;jkw;wtw;iw fPwptpLf.
tpz;zg;gjhuhpd; ifnahg;gk;.
tpz;zg;gfhuh; gw;wpa rhd;wpjo; (,r; rhd;wpjo;fSf;F fl;lzk; mwtplg;glhJ)
............................................................................................................ ,y; trpf;Fk; ..................... vd;Dk; ngaUila
ehd; tpz;zg;gfhuuhfpa .......................................................................... I fle;j ................. tUl fhykhf Nehpy; njhpe;j
tifapy; tpz;zg;gfhuh; ,yq;ifg; gpuahzg; gj;jpuj;ijg; ngwj;jFe;jtnud;W ,j;jhy; rhd;wspf;fpd;Nwd;.
tpz;zg;gfhuh; vdJ Kd;dpiyapy; ............................................ vd;Dk; ,lj;jpy; 20...... Mk; Mz;L ............ Mk; khjk;
....... Mk; ehsd;W jdJ tof;fkhd ifnahg;gj;ij ,l;Ls;shh;.
gjtpepiy/ njhopy;rhu; gjtp :.
cj;jpNahf Kj;jpiu
................
mj;jhl;rpg;gLj;jpathpd; ifnahg;gk;
jaTnra;J ftdpff
; Tk; :
1. ,e;j mj;jhl;rpr; rhd;wpjiof; ifnahg;gkpLgth;fs; tpz;zg;gfhuiu Nehpy; njhpe;jpUe;jhy; khj;jpuNk mjpy; ifnahg;gkplyhk; vd;gijf; ftdpf;f
Ntz;Lk;.
2. Nkw;Fwpg;gplg;gl;l rhd;Wgfh;jy; ,yq;if murhq;f rptpy; epHthf cj;jpNahfj;jh;/ fy;tp/nghwpapay;/fzf;fhsH/rkhjhd ePjthd;/ jifik ngw;w
kUj;Jt cj;jpNahfj;jh;/ rl;lj;juzp/ jpl;lkply; Nrit cj;jpNahfj;jh;fs; MfpNahhpdhy; kl;Lk; nfhLf;fg;gl Ntz;Lk;.
Date : ......................................
...............................................
Signature of the Applicant
...............................................
Signature of the Attestor
Please Note :
(1) The Persons signing this certificate of attestation should note that they can sign here only on the personal knowledge about the applicant.
(2) The above certification could be given only by a Sri Lanka Administrative Service/ Education Administrative Service/ Accountants Service
/ Planning Service / Commissioned Officer of Army, Navy, Airforce or Police/ Engineering Servic, Justice of the Peace, Qualified Medical
Practitioner or by an Attorney-at-Law.
IM 35 (B)
ldhd,hSh m%fhdackh i|yd
CA
fi.. 3.5 x 4.5 ^iq odrh rys;j& m%udKfha jK PdhdrEm folla my; oelafjk fldgqj, w,jkak' ialEka lrkq ,nk PdhdrEmh u;
lsisjla ,su fyda i,l=Kq ;eu fyda fkdl< hq;=h'
jaT nra;J 3.5 x 4.5 nr.kP. mstpyhd (nts;isf;fiu jtph;e;j) ,uz;L th;z epow; glq;fis fPNoAs;s ,lj;jpy; xl;lTk;. gjpg;gjw;fhd epow;glj;jpy;
vOjNth my;yJ vt;tpjkhd milahsNkh ,lf;$lhJ.
Please affix two colour photographs of size 3.5 cm x 4.5 cm (without white border) in the spaces below. Do not write or mark anything on the
photograph to be scanned.
jeo.;a '- ol=Kq mi w,jd we;s PdhdrEmh u; iy;sl lrkakd iska w;aika l< hq;=h'
Kf;fa
p khdJ .- tyJ gf;fj;jpy; xl;lg;gl;l epow;glj;ij mj;jhl;rpg;gLj;jy; Ntz;Lk;.
IMPORTANT .- THE PHOTOGRAPH AFFIXED AT THE RIGHT SIDE SHOULD BE CERTIFIED BY THE ATTESTOR.
PdhdrEmhla fuys
w,jkak.
PdhdrEmhla fuys
w,jkak.
epow;glj;ij ,q;Nf
xl;lTk;
epow;glj;ij ,q;Nf
xl;lTk;
AFFIX A
PHOTOGRAPH HERE
AFFIX A
PHOTOGRAPH HERE
uqdj
Kj;jpiu
my;yJ
ngaur;R
Stamp or
frank
ialEka lrkq ,nk PdhdrEmh
PHOTOGRAPH TO BE SCANNED
VERIFICATION PHOTOGRAPH
rhpghh;f;Fk; Gifg;glk;
gjpg;gjw;fhd epow;glk;
my; oelafjk fldgq fol ;=< l bj, fkd.Efjk m Tf w;aik fjk fjku ;nkak'
fPNo cs;s ,uz;L $LfSf;Fs;Sk; jaT nra;J cq;fs; ifnahg;gj;ij ,lTk;. ifnahg;gk; $Lfspy; Kl;lf; $lhJ
Please place your signature inside both cages below. Signature should not touch the border.
................................................................
iy;sl lrkakdf.a w;aik
cWjpg;gLj;Jgthpd; ifnahg;gk;
ENTERED BY
SCANNED BY
PRINTED BY
FEE COLLECTED BY
AMOUNT
RECEIPT No.
PASSPORT TYPE
QA BY
Wmfoia
jeo.;a(
wi;H f;dr;=re iemhSu" l+g f,i ;ekQ fyda jHdc f,aLk bosrsm;a lsu" oekg we;s .uka ,sh,a, inkaOfhka ia;r fy<sor fkdlsrSu yd j,x.= .uka ,sh,a,la <
;ndf.k ;j;a .uka ,sh,a,la ,nd.ekSug W;aidy lsrSu ovqqj ,eh yels jrols' wimQKj fyda jer iys;j imQK l< fyda jHdc f,aLk iu bosrsm;a lrk
whm;a m%;sfam lrkq ,ef' whlre fm!oa.,slj meK whm; Ndrh hq;=h'
^w&
^wd& PdhdrEm (
udi 3la we;=,; ,nd.;a fika g 3'5 x 4'5 m%udKfha fyd| ;;a;ajfha jK PdhdrEm 3la" bka folla PdhdrEm yd w;aika ldmf;a
^wd'' 35 & w,jd ii|d ne,Sf PdhdrEmh u; whlre ms<sn|j iy;slh fok ;eke;a;d iska iy;sllr ;sh hq;=h' ;=kajk
PdhdrEmh whm;%fha uq,a msgqf fjkal< fldgqj ;=< w,jkak'
^we& brsm;a l< hq;= f,aLk (
whm; iu.Z my; i|yka ,sh,s tajdfha Pdhd msgm;a iu. bosrsm;a l< hq;=h' wjYH lghq;= lsfuka miq uq,a msgm;a wdmiq ,nd fokq
we;'
(i) Wmamekak iy;slh" (ii) mqoa., yekqm;" (iii) ,shdmx lsfuka mqrjeisNdjh ,enQfjla k mqrjeis iy;slh" (iv) fjk;a rgl
mqrejeisNdjh ,nd ;sf k Y%S ,xld oa;aj mqrjeis iy;slh" (v) iajd mqreIhdf.a jdi.u mds lrkafka k jdy iy;slh"
(vi) l,ska ,nd.;a .uka ,sh,a,la we;ak th iy tys PdhdrEmh yd o;a; igyka we;=<;a msgj
q , Pdhd msgm;a" (vii) jD;a;h
s $;k;=r$ks,h
ikd: lrk ,smsf,aLk" (viii) orejkaf.a k we;=<;a lrkafka k wd'' 35 iS wdlD;sfha i|yka ,sh,s" (ix) wjq' 16g wvq orejka i|yd
.uka n,m;a ,nd .ekSf my; i|yka ,shlsh,s bm;a l< hq;=h(^w& foumshkaf.a leue;a; m%ldYs; ,smsh"
^wd& foumshkaf.a .uka n,m;%j, msgm;a ^o;a; msgqj iy <uhska ia;r msgqj&
^we& foumshka .uka n,m;% ,ndf.k fkdue;s k th ;yjqre lsu i|yd jqre m%ldYh'
^wE& .dia;= (
ishu rgj,a i|yd
ueofmr. we;= ksYa; rgj,a
i|yd
tla
re' 500 hs
re' 2"500 hs
whlre wjidk jrg ,nd .;a .uka ,sh,a, ke;sjQfha k ( re' 10"000 l w;sfl .dia;=jls' ^jir 10la we;=<;&
.dia;= ixfYdaOkhkag hgf;a f' .dia;=j fjkqfjka ,m;la ksl=;a flf' miq lf,l uiS i|yd ,m;a iq/lsj ;nd .kak'
mwpTWj;jy;fs;
jtwhd jfty;fisf; nfhLg;gJk;> Nkhrb my;yJ Nghypahd gj;jpuq;fisr; rkh;g;gpg;gJk;> jw;nghOJ itj;jpUf;fk; gpuahzg;gj;jpuk; gw;wpa tpguq;fisf;
nfhLf;fj; jtWjYk;> nry;Ygbahd Xh; gpuahzg; gj;jpuj;ij itj;jpUf;Fk; NghJ gphpnjhU gpuahzg; gj;jpuk; ngWtjw;F vj;jdpj;jYk; jz;lidf;Fhpa
Fw; w q; f shFk; . G+h; j ; j pahfhj my; y J jtwhf epug; g g; g l; l tpz; z g; g q; f s; my; y J Nghypahd gj; j puq; f Sld; rkh; g ; g pf; f g; g Lk; tpz; z g; g q; f s;
Vw;Wf;nfhs;sg;glkhl;lhJ. tpz;zg;gk; tpz;zg;gjhhpahy; Neubahff; nfhLf;fg;gl Ntz;Lk;.
(m)
(M) epow;glq;fs;
3.5 nr. kP. 4.5 nr. kP. mstpyhd 03 khjq;fSf;Fs; ngwg;gl;l ey;y jukhd 03 epow;glq;fs; epow;gl ifnahg;g ml;il F. F. 35gp apy; xl;lg;gl
Ntz;Lk;. rhpghh;f;Fk; epow;glk; tpz;zg;gj;ij cWjpg;gLj;Jgtuhy; cWjpg;gLj;jg;gl Ntz;Lk;. %d;whtJ epow;glk; 01 Mk; gf;fj;jpy; xl;lg;gl
Ntz;Lk;.
(,) rkh;g;gpf;fg;gl Ntz;ba gj;jpuq;fs;
gpdt
; Uk; gj;jpuq;fs; epow;glg; gpujpfSld; nghUj;jkhdtplj;J tpzz
; g;gj;Jld; rkh;gg; pff
; g;gl Ntz;Lk;. %yg;gpujpfs; ghh;itaplg;gl;l gpdG
; kPsspff
; g;gLk;.
(1) gpwg;Gr;rhd;wpjo; (2) nrhe;j milahs ml;il (3) gjpTg; gpui[ahdhy; gpurhThpikr; rhd;wpjo; (4) ,ul;ilg; gpurhThpikr; rhd;wpjo; (5) tpthfr;
rhd;wpjo; fztdpd; Kjw;ngaiug; ghtpg;gjhdhy; (6) jw;NghJ itj;jpUf;Fk; gpuahzg; gj;jpuKk; epow;glq;fSilaJk; juTg;gf;fq;fSilaJk;
epow;glg; gpujpfSlDk; (7) njhopy;rhh; gjtp/ gjtp/ gjtp epiy Mfpatw;iw ep&gpf;ff;$ba gj;jpuq;fs; (8) gps;isfs; Nrh;fg;gltpUe;jhy; F.F. 35rP
apd; gb rk;ge;jg;gl;l gj;jpuq;fs; (9) taJ 16 f;F cl;gl;lth;fs; flTr;rl
P ;ilg; ngw Ntz;Lkhapd; gpd;tUk; Mtzq;fis rkh;g;gpf;f Ntz;Lk;:(m) ghJfhtyHfspd; tpUg;gf; fbjk;
(M) ghJfhtyh;fspd; flTr;rl
P ;bd; Gifg;glg; gpujp (juTg; gf;fKk; gps;isfSila gf;fKk;)
(,) ghJfhtyh;fSf;F flTr;rl
P ;L ,y;yhj gl;rj;jpy; rj;jpaf; fljhrp rkh;g;gpj;jy; Ntz;Lk;.
flTr;rl
P ;L rfy ehLfs;
flTr;rl
P ;L Fwpg;gpl;l ehLfs; (kj;jpa fpof;F cl;gl)
&gh 500.00
&gh 2>500.00
cq;fs; flTr;rl
P ;L njhiye;jpUe;jhy; Nkyjpf fl;lzkhf &gh 10>000.00 mwtplg;gLk;. (10 tUlq;fSf;Fs;)
fl;lzq;fs; khw;wj;jpw;Fhpad. gw;Wr;rPl;L toq;fg;gLk;. vjph;fhy njhlHGfSf;F mjid itj;jpUf;fTk;.
N.B. :
It is a punishable offence to furnish false information, to forward fraudulent or forged documents, to abstain from declaring particulars
regarding the Travel Document presently held, and to attempt to obtain another Travel Document while being in possession of a valid
Travel Document. Incomplete or erroneously filled applications or applications forwarded with forged documents will be rejected. The
applicant should hand over the application in person .
INSTRUCTIONS
(A)
(B) Photographs :
03 colour photographs, size 3.5 c.m. x 4.5 c.m. taken within 03 months and in good quality should be pasted on the photo/signature
card I.M. 35B. Verification photograph should be certified by the person who attests the application. The third photograph should be
pasted on page 01.
(C) Documents to be forwarded :
Following documents together with photo copies, if applicable, should be forwarded with the application. Originals will be returned
after perusal:(i) Birth Certificate (ii) Personal Identity Card (iii) If Citizen by registration the Citizenship Certificate (iv) Dual Citizenship Certificate
(v) Marriage Certificate, if using husbands surname (vi) Travel Document presently held with photocopies of photographs and Data
page of same (vii) Documents in proof of profession/post/designation, (viii) If children are to be included relevant documents as per
I.M. 35 C. (ix) If this application is submitted for a child whose age is under 16, the following documents should be produced:(a) The letter of consent from the parents
(b) Photocopy of parents Passports (Data page and Children Page)
(c) An affidavit should be produced if the parents do not Posses the Passports.
(D)
Fees :
Passport - All Countries
Rs. 500.00
Rs. 2,500.00
An extra charge of Rs. 10,000.00 will be levied, if your Travel Document is lost. (within ten years)
Fees are subject to revision. A receipt will be issued. Please retain same for future reference.
ldhd,Sh m%fhdackh i|yd $ mYty cgNahfj;jpw;F khj;jpuk; /For Office use only
..............................................................
Date : ........................................
ISSUING INFORMATION
(1)
(2)
..............................................................
Date : ........................................
..............................................................
..............................................................
Date : ........................................
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