¢X.BC.

¢f glj - 1 (¢he¡j¨−mÉ fÊ¡fÉ)

A¡−hceL¡l£l HL¢V l¢Pe

55 ^ 45 ¢jx¢jx A¡L¡−ll
R¢h A¡W¡ ¢c−u m¡N¡−e¡l fl
paÉ¡ue Ll−a q−h
Affix the photograph
here and attest on the
photo
Machine Readable Passport Application Form
A¡−hceL¡l£l ¢fa¡l A¡−hceL¡l£l j¡a¡l
NZfÊS¡a¿»£ h¡wm¡−cn plL¡l HL¢V l¢Pe 30 ^ 25
¢jx¢jx A¡L¡−ll R¢h
HL¢V l¢Pe 30 ^ 25
¢jx¢jx A¡L¡−ll R¢h
h¢ql¡Nje J f¡p−f¡VÑ A¢dcçl A¡W¡ ¢c−u m¡N¡−e¡l fl A¡W¡ ¢c−u m¡N¡−e¡l
paÉ¡ue Ll−a q−h fl paÉ¡ue Ll−a q−h
−j¢ne ¢l−Xhm f¡p−f¡VÑ A¡−hce glj Affix applicant’s
Father’s photograph
Affix applicant’s
Mother’s photograph
here and attest on the here and attest on the
photo photo

−Lhmj¡œ 15 hvp−ll e£−Q AfË¡çhuú

A¡−hceL¡l£l −r−œ Ef−l¡š² R¢hàu fË−u¡Se z

• A¡−hce fœ¢V f¨lZ Ll¡l f¨−hÑ Ae¤NÊqf§hÑL −no fªù¡u h¢ZÑa p¡d¡le ¢e−cÑne¡pj§q paLÑa¡l p¢qa f¡W Ll²ez
Please read carefully the General Instructions at the last page before filling the form.
• a¡lL¡ (*) ¢Q¢q²a œ²¢jL ew …−m¡ AhnÉ f¨lZ£uz
Serial numbers marked with star (*) marks must be filled in.
• œ²¢jL ew 1 hÉa£a AeÉ¡eÉ œ²¢jL Cw−lS£−a (Capital Letters) f¨lZ£u z
Except serial number 1, all other serials must be filled in English (Capital Letters).

* B’¢mL f¡p−f¡VÑ A¢gp/h¡wm¡−cn ¢jne x Bangladesh Embassy, Washington D.C. * A¡−hc−el fÊL«¢a x ea¤e f§ex fËc¡e
Name of RPO / Bangladesh Mission Application type New Reissue

* A¡−hceL«a f¡p−f¡−VÑl fÊL«¢a x p¡d¡le A¢g¢pu¡m L¤V¯e¢aL

Type of passport applied for Ordinary Official Diplomatic

* f¡p−f¡VÑ ¢hal−Zl fÊL«¢a x p¡d¡le Sl¦l£

Type of delivery Regular Express

hÉ¢š²Na J e¡N¢lLaÄ pwœ²¡ñ abÉ (Personal & Citizenship Details)

1z A¡−hceL¡l£l e¡j (h¡wm¡u) x ________________________________________________________________

Name of Applicant (in Bengali)
2z* A¡−hceL¡l£l e¡j x _______________________________________________________________________
Name of Applicant
3z* B−hceL¡l£l e¡j - A¡f¢e f¡p−f¡−VÑ e¡j −ki¡−h ®cM−a Q¡e ®pi¡−h V¡Cf Ll¦e z p−hÑ¡μQ 48¢V Arl hÉhq¡l Ll¡ k¡−hz
Name of Applicant – Type as you want it to appear in your passport. Maximum 48 characters are allowed.

(e¡−jl ®no¡wn 2u Aw−n ¢mM−a q−h Hhw 1j Aw−n HL¡¢dL Awn b¡L−m fË¢a Aw−nl j¡TM¡−e 1¢V Ol n§eÉ ®l−M f§lZ Ll−a q−h z The last
part of the name should appear in second part. Keep a blank space between two parts of the name).
fÊbj Awn First Part (Given Name)

¢àa£u Awn Second Part (Surname)

4z* ¢fa¡l e¡j x _______________________________ −fn¡ x ___________________ S¡a£ua¡ x _____________

Father’s Name Profession Nationality

5z* j¡a¡l e¡j x ________________________________ −fn¡ x ___________________S¡a£ua¡ x ____________

Mother’s Name Profession Nationality

6z ð¡j£/ Ù»£-l e¡j x ________________ _______−fn¡ x ___________________ S¡a£ua¡ x ____________

(fÊ−k¡SÉ q−m) Spouse’s Name Profession Nationality
(if applicable)

7z A¢ii¡h−Ll e¡j x _____________ __________−fn¡ x ___________________ S¡a£ua¡ x ____________

(fÊ−k¡SÉ q−m) Guardian’s Name Profession Nationality
(if applicable)

f¡a¡-1
8z* ¯hh¡¢qL AhÙÛ¡ (3) ¢Qq² ¢ce x A¢hh¡¢qa ¢hh¡¢qa ¢hfaÀ£L / ¢hdh¡ a¡m¡LfÊ¡f¹
Marital Status Unmarried Married Widower/Widow Divorced
Put (3) in appropriate box
9z* −fn¡ x _____________________________________________________________________________ _
Profession
A¢g¢pu¡m f¡p−f¡−VÑl −r−œ x (In case of Official Passport)
A¢g−pl e¡j x ____________________________________________ Ahpl NÊq−el a¡¢lM x ________________
Name of the Office Date of Retirement
10z* SeÈÙÛ¡e (®cn J −Sm¡) x ®c−nl e¡j ___________________________ −Sm¡l e¡j ______________________
Place of Birth Country District

11z* SeÈ a¡¢lM x ¢ce j¡p hvpl

Date of Birth Day Month Year

12z* ¢mwN (3) ¢Qq² ¢ce x f¥l¦o j¢qm¡ AeÉ¡eÉ

Gender (3) in appropriate box Male Female Others
13z* SeÈ pecfœ ew x
Birth Identification
Number
Or Abh¡
S¡a£u f¢lQuf−œl ew x
National Identification
Number

14z ¢VA¡CHe (k¢c b¡−L) x - -

Tax Identification
Number (if available)
15z* EμQa¡ x −px¢jx Or C¢’ 16z* djÑ x
Height cm Abh¡ inch Religion
17z* h¡wm¡−cn£ e¡N¢lL−aÆl p§œ x S¸jp§−œ hwnp§−œ A¢ih¡pe ®cn£uLlZ p¤−œ
(¢VL (3) ¢Qq² ¢ce) by birth by descent Migration Naturalization
Type of Citizenship ¯hh¡¢qLp§−œ AeÉ¡eÉ, E−õM Ll¦e
Put (3) in appropriate box by marriage Others, please specify __________________ _______
18z ®~àa e¡N¢lL q−m e¡N¢lLaÆ fÊc¡eL¡l£ ®c−nl e¡j x _________________________ f¡p−f¡VÑ ew _________________
Name of the other country in case of dual citizenship Passport No.
19z* haÑj¡e ¢WL¡e¡ x (h¡wm¡−c−n A¡−hc−el ®r−œ fË−k¡SÉ) (Applicable only when applying in Bangladesh)
Present
Address NÊ¡j / h¡p¡ _____________________ ________ l¡Ù¹¡/hÓL/−pƒl _______________ ______
Village/House Road/Block /Sector
b¡e¡ ___________________________________ X¡LOl ___________________________
Police Station Post Office
−Sm¡ __________________________________ −f¡ØV®L¡X
District Post Code
®g¡e eðl C-®jCm ¢WL¡e¡
Contact Number e-mail Address
Øq¡u£ ¢WL¡e¡ J haÑj¡e ¢WL¡e¡ HLC q−m ¢VL (3)¢Qq² ¢ce
Put (3) if Permanent Address is same as Present Address
20z* ÙÛ¡u£ ¢WL¡e¡ x NÊ¡j/h¡p¡ _______________________ ______ l¡Ù¹¡/hÓL/−pƒl________________________
Permanent Village/House Road/Block /Sector
Address b¡e¡ ___________________________________ X¡LOl ___________________________
Police Station Post Office
−Sm¡ __________________________________ −f¡ØV−L¡X _________________________
District Post Code
®g¡e eðl C-®jCm ¢WL¡e¡
Contact Number e-mail Address
f¡a¡-2
21z ¯h−c¢nL ¢WL¡e¡ x (¯h−c¢nL ¢WL¡e¡ −Lhmj¡œ h¡wm¡−cn ¢jn−e A¡−hc−el ®r−œ fË−k¡SÉ)
Overseas (Applicable only when applying in Bangladesh Missions)
Address
¢WL¡e¡
Address

®cn ®g¡e/gÉ¡„ eðl C-®jCm ¢WL¡e¡

Country Phone/Fax Number e-mail Address

22z* Sl¦l£ fË−u¡S−e ®k¡N¡−k¡−Nl SeÉ hÉ¢š²l ¢hhlZ x (in Bangladesh)

(Emergency contact person’s details)
e¡j x A¡−hceL¡l£l p¡−b pÇfLÑ x
Name Relationship with the applicant
¢WL¡e¡ x Vill/House Road/Block/Sector
Address
PS PO: District:

®g¡e/gÉ¡„ eðl C-®jCm ¢WL¡e¡

Phone/Fax Number e-mail Address

23z f§−hÑ fÊc¡eLªa f¡p−f¡VÑ eðl (fÊ−k¡SÉ q−m) x Cp¤Él ÙÛ¡e J a¡¢lM
Previous passport details (if applicable) Place and Date of Issue

f¡p−f¡VÑ f¢lhaÑ−el L¡lZ (3) ¢Qq² ¢ce x f¢lhaÑe hÉhq¡−ll Ae¤fk¤š² −ju¡c Eš£ZÑ q¡l¡−e¡
Reason for re apply Conversion Unusable Expired Lost
Put (3) in appropriate box

¢S¢X eðl (fÊ−k¡SÉ ®r−œ) b¡e¡l e¡j a¡¢lM

GD No. (if applicable) Name of the Police Station Date

24z A¡−hce f−œl p¡−b pwk¤š² c¢mm¡¢c x

(Enclosures attached with the application form)
S¡a£u f¢lQuf−œl g−V¡L¢f SeÈ ¢ehåe pe−cl g−V¡L¢f plL¡l£ A¡−c−nl (¢SJ) g−V¡L¢f
(Copy of National ID) (Copy of Birth RegistrationCertificate) (fË−k¡SÉ ®r−œ) (Copy of Government Order)
R¡sf−œl (HeJ¢p) L¢f ¢hcÉj¡e f¡p−f¡−VÑl g−V¡L¢f ®VL¢eLÉ¡m pe−cl g−V¡L¢f
(fË−k¡SÉ ®r−œ)(Copy of NOC) (fË−k¡SÉ ®r−œ)(Copy of Previous Passport) (fË−k¡SÉ ®r−œ)(Copy of Technical Certificates)

¢VA¡CHe pe−cl g−V¡L¢f ¢f¢XHp/Ahp®ll a¡¢l®Ml fÊj¡efœ

(fË−k¡SÉ ®r−œ) (fË−k¡SÉ ®r−œ) (PDS/Proof of Retirement Date)
(Copy of TIN Certificate)

25z* f¡p−f¡−VÑl SeÉ ¢gp Sj¡ pwœ¦¡¿¹ abÉ¡hm£ (−k abÉ…−m¡ fË−k¡SÉ q−h) x Payment Information
hÉ¡wL/h¡wm¡−cn ¢jne Sj¡Lªa ¢g Hl f¢lj¡e (V¡L¡/j¡¢LÑe Xm¡l )
Name of the Bank/Bangladesh Mission Amount deposited (US$ in case of Bangladesh Missions)

n¡M¡ l¢nc ew a¡¢lM

Branch Receipt/Transaction No. Date

AwN£L¡l e¡j¡ (Declaration)

1z A¡¢j nfb L−l hm¢R ®k A¡−hcef−œ fÊcš ph abÉ paÉ Hhw ®L¡e ¢jbÉ¡ abÉ ¢c−u b¡L−m A¡¢j A¡Ceax cäe£u qhz
2z A¡¢j A¡−l¡ fÊ¢a‘¡ Ll¢R A¡¢j/A¡j¡l p¿¹¡e h¡ ®f¡oÉ, ®k ®L¡e L¡l−Z Ai¡hNÊÙÛ q−u fs−m ¢h−cn ®b−L A¡j¡−L Abh¡ A¡j¡l ®f¡oÉ−L ®c−n fÊaÉ¡haÑe
Ll¡l ®r−œ k¡ha£u MlQ f¢l−n¡−d h¡dÉ b¡Lh Hhw ¢h−c−n A¡j¡l/A¡j¡l p¿¹¡e h¡ ®f¡−oÉl jªaɤ OV−m jl−c−ql f¢lhqe MlQ A¡j¡l °hd Ešl¡¢dL¡l£/A¡j¡l L¡R
®b−L A¡c¡u−k¡NÉ q−hz

a¡¢lM x _____________________ A¡−hceL¡l£l/A¢ii¡h®Ll (A¡−hceL¡l£ AfÊ¡ç huú q−m)

ü¡rl h¡ ¢VfpC (Aef−eu L¡¢m−a)

f¡a¡-3
 No need to fill-up this page by the Applicant in abroad

fËaÉue (Certification)

A¡j¡l ‘¡e J ¢hnÄ¡pj−a Ef−l h¢ZÑa abÉ paÉ Hhw B−hceL¡l£ hvpl k¡hv A¡j¡l f¢l¢Qaz ¢a¢e A¡j¡l pjȤ−M A¡−hcef−œ ü¡rl /
¢VfpC fËc¡e L−l−Rez

paÉ¡ueL¡l£l A¡h¡¢pL ¢WL¡e¡ x

paÉ¡ueL¡l£l e¡j J ü¡rl
f¡p−f¡VÑ/S¡a£u f¢lQu fœ ew a¡¢lM x _____________
−V¢m−g¡e eðl (k¢c b¡−L) (p£m ®j¡ql)

f¤¢mn ®i¢l¢g−Lne ¢l−f¡VÑ(Police Verification Report)

f¤¢mn ®i¢l¢g−Lne eðl x _______________________________________________ a¡¢lM x_____________________

A¡−hceL¡l£l a−bÉl paÉa¡ k¡Q¡C x

p¢WL p¢WL eu

p¢WL e¡ q−m L¡lZ (h¡wm¡−cn£ e¡N¢lL ee/p¡S¡fË¡ç/ j¡jm¡d£e/ ¢WL¡e¡ p¢WL eu/ AeÉ¡eÉ L¡lZ) x

_____________________________ ________________________ _____________________________

fË¢a−hce CpɤL¡l£ A¢gp¡−ll ü¡rl p¤f¡li¡C¢Sw A¢gp¡−ll ü¡rl fË¢a−hce fÊ¢aü¡rlL¡l£ A¢gp¡−ll ü¡rl
(f¤¢mn BC¢X J p£m) (f¤¢mn BC¢X J p£m) (f¤¢mn BC¢X J p£m)

¢e−cÑne¡ (General Instruction)

A¡−hceL¡l£−L ¢ejÀ¢m¢Ma c¢mm¡¢c B−hcef−œ AhnÉC pwk¤š² Ll−a q−h

1z plL¡l£, A¡d¡plL¡l£, ü¡ušn¡¢oa J l¡øË¡uaÄ pwÙÛ¡l ÙÛ¡u£ LjÑLaÑ¡/LjÑL¡l£, AhplfË¡ç plL¡l£ Q¡L¤l£S£¢h J a¡−cl ¢eiÑln£m Ù»£/ü¡j£ Hhw plL¡l£
Q¡L¤l£S£¢hl 15 (f−el) hvp−ll Lj hu−pl p¿¹¡e, 5 (fy¡Q)/10 (cn) hvp−ll A¢aœ¦¡¿¹, pjfÑeLªa (p¡−lä¡lX) ®cl SeÉ HL¢V glj J AeÉ¡eÉ−cl ®r−œ ea¤e
f¡p−f¡−VÑl SeÉ 02 (c¤C) L¢f f§lZLªa f¡p−f¡VÑ glj c¡¢Mm Ll−a q−h z
2z AfË¡çhuú (15 hR−ll Lj) A¡−hceL¡l£l −r−®œ A¡−hceL¡l£l ¢fa¡ J j¡a¡l HL¢V L−l l¢Pe R¢h (30 ^ 25 ¢jx¢jx) R¢h A¡W¡ ¢c−u m¡N¡−e¡l fl paÉ¡ue
Ll−a q−hz
3z S¡a£u f¢lQufœ Abh¡ SeÈ ¢ehåe pec Hhw fË−k¡SÉ ®r−œ fË¡p¢‰L ®VL¢eLÉ¡m pecpj§−ql (−kje X¡š²¡l, C¢”¢eu¡l, XË¡Ci¡l CaÉ¡¢c) paÉ¡¢ua g−V¡L¢fz
4z −k pLm hÉ¢š²NZ f¡p−f¡−VÑl A¡−hcefœ J R¢h fËaÉ¡ue J paÉ¡ue Ll−a f¡l−he- pwpc pcpÉ, ¢p¢V L−fÑ¡−ln−el ®jul, ®Xf¤¢V ®jul J L¡E¢¾pmlNZ,
®N−S−VX LjÑLaÑ¡, f¡h¢mL ¢hnÄ¢hcÉ¡m−ul ¢nrL, Ef−Sm¡ f¢lo−cl ®Qu¡ljÉ¡e J i¡Cp ®Qu¡ljÉ¡e, CE¢eue f¢lo−cl ®Qu¡ljÉ¡e, ®f±lpi¡l ®jul J ®f±l
L¡E¢¾pmlNZ, ®hplL¡l£ ¢hnÄ¢hcÉ¡m−ul AdÉ¡fL, −hplL¡l£ L−m−Sl AdÉr, −hplL¡l£ EμQ ¢hcÉ¡m−ul fËd¡e ¢nrL, S¡a£u °c¢eL f¢œL¡l pÇf¡cL, ®e¡V¡l£
f¡h¢mL J A¡d¡plL¡l£/ü¡ušn¡¢pa/l¡øËu¡š pwÙÛ¡l S¡a£u ®hae ®ú−ml 7j J ac¤dÄÑ ®NË−Xl LjÑLaÑ¡NZ z
5z fË−k¡SÉ ®r−œ fË¡p¢‰L ¢S J (GO)/ He J ¢p (NOC) c¡¢Mm Ll−a q−h z
6z L§V¯e¢aL f¡p−f¡VÑ m¡−il ®k¡NÉ A¡−hceL¡l£NZ−L f§lZLªa glj J pwk¤¢š²pj¤q fll¡øË j¿»Z¡m−u Sj¡ ¢c−a q−h z
7z e¡−jl pw¢rçl©−fl f¢lh−aÑ f§ZÑl©−f ( ®kje-−j¡x/MD. Hl ÙÛ−m ®j¡q¡jÈc/MOHAMMAD) ¢mM¡ h¡“e£u z ¢nr¡Na h¡ Q¡L¤l£p¤−œ fË¡ç fch£pj§q (−kje
X¡š¦¡l, C¢”¢eu¡l, Xƒl, ¢fHCQ¢X CaÉ¡¢c) e¡−jl Awn ¢q−ph f¢lN¢Za q−h e¡ z gl−jl œ¦¢jL ew 3 f§l−Zl ®r−œ, HL¡¢dL Awn b¡L−m fË¢a Aw−nl j¡TM¡−e
1¢V Ol n§eÉ ®l−M f§lZ Ll−a q−h z A¡−hceL¡l£l ¢fa¡, j¡a¡, ü¡j£/Ù»£ jªa q−mJ, a¡l/a¡−cl e¡−jl f§−hÑ "jªa/jlýj/Late' ®mM¡ k¡−h e¡ z

A¢g−pl hÉhq¡−ll SeÉ (FOR OFFICIAL USE ONLY)

1z abÉ pwNËqL¡l£ (Af¡−lVl) Hl e¡j, BC¢X J ü¡rl

2z A¡−hce NÊqeL¡l£ A¢gp¡−ll e¡j, BC¢X J ü¡rl

3z f¡p−f¡VÑ Cpɤ Ae¤−j¡ceL¡l£ LjÑLaÑ¡l e¡j, BC¢X J ü¡rl

4z Cp¤ÉL«a f¡p−f¡VÑ eðlx f¡p−f¡VÑ ¢haleL¡l£ A¢gp¡−ll e¡j, BC¢X J ü¡rl

5z A¡−hceL¡l£l f¡p−f¡VÑ fÊ¡¢çl ü¡rl J a¡¢lM

f¡a¡-4
 Important information on Re-issue / Renew of an existing
MRP (Machine Readable Passport)

1. If you do not wish to change your photograph / signature: you may not need to visit the
Embassy physically. Please fill in an MRP application form (in PDF format, without barcode)
and send it to the Embassy by postal mail along with the following (requirements):

(a) One copy of recent photograph (size 55x45mm);

(b) Photocopy of the current passport with original;
(c) Photo copy of 17-digit Birth Certificate or National ID Card (which mentioned in your
previous MRP);
(d) A money order/bank draft of US$ 110 (for Ordinary Delivery) / US$ 220 (for Express
Delivery) addressed to the ‘Embassy of Bangladesh’;
(e) Proof of Occupation (if applicant is Engineer, Physician, Researcher, Teacher, Student,
Driver or any special occupation). For Private Service, no proof of occupation is
required;
(f) Copy of Marriage Certificate (if applicant is married);
(g) Proof of non-US citizen or any foreign national (Photocopy of Green Card/Permanent
Resident Card or Work Permit or I-20 etc). If applicant is US citizen or any foreign
national, please provide a photocopy of Dual National Certificate.

2. If you want to change your photograph/signature in your re-issued passport, please contact
the Embassy over phone to set an appointment; and follow the procedure as you would do
during obtaining a new MRP. You may also visit one of our mobile MRP enrolment camp
when it comes to your area. Please see the above-mentioned schedule, if any. For more
information, please call us or keep an eye on our website.

3. If a machine readable passport was issued when the holder was a minor due to which
biometric information was not recorded, and now the holder has attained 15 years of age, the
holder needs to visit the Embassy or a mobile enrolment facility. In this case, please follow
the procedure of obtaining of a new MRP as mentioned in 2. above.

Mailing service:

A self-addressed prepaid envelope for return mail service preferably USPS Certified with tracking
number /Express Mail Flat Rate (from US Post Office) / UPS or FedEx Prepaid label by the
applicant. Your passport will be sent to you once it is received from Dhaka. The return envelope
is not required if the applicant wishes to collect the MRP (Passport) from the Embassy physically.

Processing time for MRP:

Application and requirements are received at the counter between 10:00 a.m.–1:00 p.m., Monday
to Friday, except holidays. Delivery time is from 3:30–5:00 p.m.

Please note that the Bangladesh Embassy needs at least 45 to 60 days (60-days for Ordinary
Delivery / 45-days for Express Delivery) to process the MRP application.

i. Please check the spelling and accuracy of the data that you have provided while filling
in your application form since these will be reflected in your passport and fulfill all
requirements to avoid any delay in processing;
ii. Any misrepresentation of facts may lead to cancellation of MRP at any time.