MYcRvZx evsjv`k miKvi

ewnivMgb I cvmcvU Awa`i

wiBmy/Z_ cwieZb/mskvab Ave`b dig
Reissue/Information Alteration/Correction Application Form
digwU cvmcvUi gqv` DxY, Z_ cwieZb/gy`YRwbZ fzj mskvab msv welq eeZ ne|
This form will be used to reissue, to change the information/rectify the printing errors of passport.

wb`kbv t digwU BsiwRZ (CAPITAL LETTERS) c~iY Kib Ges AbyMnc~eK Avcbvi Ave`bi mv_ Dchy cgvYvw` mshy Kib|
Instruction : Please fill up the form in English (CAPITAL LETTERS) and attach relevant documents in favour of your
application.

wefvMxq/ AvwjK cvmcvU Awdm/wgkbi bvg

cvmcvU weZiYi cKwZ

Name of Divisional/Regional Passport Office/Mission

Type of delivery

mvaviY

Riwi

Regular

Express

Ave`bKvixi bvg (evsjvq)

wd c`vb msv Z_

Name of Applicant (In Bangla)

Payment of Fees

Ave`bKvixi bvg (BsiwRZ)

Name of Applicant (in English)

wdi cwigvY ($/USD)

Amount of Fee ($/USD)

evsK/wgkbi bvg

MnxZ cvmcvUi Z_

Bank/Mission

Received Passports Details

cvmcvU b^i Passport No.

kvLv

Bmyi vb Place of Issue

Branch

iwk` bs
gqv` DxYi ZvwiL Date of Expiry

Receipt No.

Bmyi ZvwiL Date of Issue

ZvwiL
Date

PvwnZ mskvab Expected Correction

cvmcvU eZgvb c`wkZ Z_
Information on existing passport

cZvwkZ cwieZb/mskvab
Expected Change/Correction

ZvwiL
Date

Ave`bKvixi/AwffveKi (Ave`bKvix Acveq nj) ^vi

Applicants/Guardians (if the applicant is a minor) Signature