Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
1. Name
4. Present address (in the United States) 5. Permanent address (in Bangladesh)
Street
House/Apt #
City
10. Name and address of children (Please use seperate sheet, if needed)
a.
b.
c.
11. Name and address relatives (living in Bangladesh) who can be contacted for reference (at least one):
a. Relationsihip
b. Relationsihip
c. Relationsihip
1
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13. Date of first leaving Bangladesh 14.a. Bangladesh Passport # 14.b. Place of issue
[e. g. 26-Mar-1971] [Please attache photocopy of Bangladesh Passport][Please attache photocopy of US Passport]
14.c. Date of issue 15. Date of acquisition of foreign citizenship 16.a. Foreign Passport #
[e. g. 26-Mar-1971] [Please attache photocopy of US naturalization certificate]
16.b. Place of issue 16.c. Date of issue 16.d. Date of expiry
[e. g. 26-Mar-1971] [e. g. 26-Mar-1971]
Date
[e. g. 26-Mar-1971]
DECLARATION OF ASSETS
(page 3 of the application set)
1. Name
2. Father's Name
I do hereby solemnly affirm and swear that the information provided above are true, correct and complete.
. Date
e. g. 26-Mar-1971 Signature of the applicant
STATEMENT OF ACTIVITIES IN THE LAST 5 YEARS
(page 4 of the application set)
1. Name
2. Father's Name
3. Description of activities
Description of Activities (Education/service/business) From To
I do hereby solemnly affirm and swear that the information provided above are true, correct and complete.
Date
e. g. 26-Mar-1971 Signature of the applicant
AFFIDAVIT FOR DUAL NATIONALITY CERTIFICATE
(page 5 of the application set)
I, (n)ame)
Present address (in the United States) Permanent address (in Bangladesh)
Street
House/Apt #
City
State
Zip code
Present occupation :
do hereby solemnly affirm and swear that the information provided in my application for dual nationality are true, correct and
complete.
In witness whereof, I have signed this affidavit before the Minister Counsellor/ Notary Public
on the day of First Secretary
Application seeking Dual Nationality should be submitted in the prescribed Form (three sets).
Following may be noted during submission of the application form:
a) If the applicant is a person temporarily residing in Bangladesh, the application shall be submitted
directly to the Government of Bangladesh (Ministry of Home Affairs);
b) If the applicant lives in a foreign country, the application should be sent through the Bangladesh
Diplomatic Mission/ Consulate to that country; and
c) Where there is no Bangladesh Mission or Consulate in a country of applicant’s residence, the
application may be sent through Bangladesh Mission or Consulate in the country nearest to that
country.
1. Affidavit affirming the truth of the statement made in the application and signed before the
Minister/Counsellor/First Secretary / Notary public/ or persons of equivalent status of the Embassy
of Bangladesh in Washington DC (please see page 5)
2. Documentary evidence regarding remittances to Bangladesh for last 3 years.
3. Copy of foreign citizenship certificate or Naturalization Certificate
4. Declaration of assets (Movable / Immovable) in Bangladesh (please see page 3). If required
please use a separate sheet. Statement of Parent's assets should be given if the applicant does not
have any asset in his /her name.
5. Statement of activities for past 5 years (service, education, business etc.) since first departure
from Bangladesh (Please see page 4). Please use separate sheet if required.
6. 4 color recent passport size photograph (print name on the back )
7. Fee: Money order of certified check of the amount of US 38.00 payable to the Embassy of
Bangladesh.
8. Copy of Birth Certificate of children born in the USA (if she/he is the applicant).
9. Copy of Parent's Bangladesh Passport (page 1-7) or Dual Citizenship Certificate in the case of
child applicant born in the USA.
10. Photocopy of Bangladesh passport page (1-7).