Professional Documents
Culture Documents
340 Albert Street, Suite:1250, Ottawa, Ontario, K1R 7Y6, Canada Tel:(613)-236-0138-39 Fax:(613)-567-3213 E-mail: bangla@rogers.com Web: http://www.bdhc.org Please attach 1 copy of 40 mm X 50 mm photograph taken within the last six months Please provide Four more copies of same size photograph
Ordinary
Urgent
1. Name: 2. Name: (as it should appear in the passport) 3. Bangladesh Nationality: 4. Date of birth: 6. Height: 8. Color of eyes: 10. Sex: Male Female Meter By Birth By Descent [day-month-year] Centimeter 7. Profession: 9. Color of hair: 11. Marital status: Single Married Widow/Widower Divorced Immigration Other (Specify)
12. Visible distinguishing marks (if any): 13. Fathers Name: 15. Mothers Name: 17. Spouses Name: 14. Fathers Nationality: 16. Mothers Nationality: 18. Spouses Nationality: Father Husband
19. Please check whose name should appear on passport [In case of married female applicants only]
Please Sign in the boxes below. Signature of the Applicant to be affixed in the passport. (Signature on Both)
_Place of issue:
[day-month - year]
Date:
Declaration: I declare on solemn affirmation as under: I am a citizen of Bangladesh and have never lost it. I have not been refused passport facilities. All previous passports granted to me have been surrendered other than the passport / travel document mentioned below which is being attached herewith. I further declare that I have not submitted any other application for passport /travel document to any Bangladesh authorities at home or abroad since the attached passport or travel document issued to me. I or my legal heir will be responsible to pay for the cost of return, for myself and my dependants journey to Bangladesh, in case of compulsory deportation or unfortunate death. To the best of my knowledge and belief the information given in this application is correct. I am fully aware that by making a statement that is not true, I will render myself liable to prosecution under the law.
Full Name:
Office Use Only : Remarks: Serial No: Date of issue: Amount(C$) Passport No: Exp Date: Receipt no:
The passport as per detail given below has been lost. In the event of its coming again into my possession, I undertake to return it to the Passport Office in Bangladesh or the nearest Bangladesh Mission abroad. Particulars of the Previous Passport:
Place of issue:
_[day-month - year]
CAUTION: Attention of the Attesters / Guarantors is drawn to the fact that by attesting any statement contained in this application that is not true s/he will render her/himself liable to prosecution under the law. I, the undersigned, a citizen of Bangladesh, hereby declare that: The applicant Ms / Mr: _is personally known to me for years.
She/he is a Bangladeshi and she/ he has signed /affirmed thumb impression on this form in my presence. To the best of my knowledge and belief, the information given in the application is correct and true. The photograph on the reverse bears her/ his likeliness. Signature: Guarantor- II
Signature: Guarantor- I
Name: Address: City : Tel : Bangladeshi Passport No: Place of Issue: Exp Date: Date of Issue: Exp Date: _Province: _Cell: Postal Code :