Sl. No.

: ______________

Dirhams

: ______________

Receiving date : _____________

Delivery date : ______________

B
EMBASSY OF THE PEOPLES REPUBLIC OF BANGLADESH
ABU DHABI, UNITED ARAB EMIRATES
P.O. BOX NO. 2504, Tel. 02 4465100, Fax : 02 4464733

APPLICATION FORM FOR PP RENEWAL / ALTERATION / ENDORSEMENT

(fpfV ehue/flhae/HpjV-Hl Se Bhcef)
[Form should be filled in block letters (glj CwlS hs qal Arl flZ Lla qh)]
1. Name (ej)

: _______________________________________________________________

2. Name of Father / Husband (fa/jl ej) : ______________________________________

3. Passport No. ________________ Date of Issue: _______________ Place of issue :______________
(fpfV ew)
(fcel alM)
(fcel e)
4. Profession as per visa (ip Aeku fn) : ____________________________________________
5. Permanent address in Bangladesh : (hwmcn u WLe)
Village (Nj) : _________________________P.O. (fV Agp) : ________________________
P.S. (EfSm): ________________________District (Sm)

: ________________________

6. Present Address in the United Arab Emirates : (Blh Bjla haje WLe)
P. O. Box No.___________City / Town:_____________________Phone: __________________
(fV h ew)
(nql)
(ge ew)
7. Purpose: Renewal / alteration of name(s) / profession / date of birth / address /
Inclusion of child (per child - 26mm. X 25 mm. sized 3 photographs required)/
New photograph endorsement (3 copies of passport size photographs)
(Enx ehue/ej/fn/Sj alM/WLe flhae/pecl Ai-Hr faLl 3 Lf 26 X 25j|j|
pCSl Rh pwk Lla qhz eSl Rh Hpl r 4 Lf fpfV pCSl Rh fuSe)
_______________________________________________________________________________
8. Details of endorsement (HpjV Hl hhlZ) :
______________________________________________________________________________
9. Supporting documents / certificates etc. submitted along with this application :
(pwk Aee fjZc/pVgLV Cac)
_________________________________________________________________________________
I do hereby solemnly declare that I am a Bangladeshi citizen and the above information provided by me are true to the
best of my Knowledge .I shall be held responsible for furnishing any false statement (Bj HC jj OoZ LlR k,

Bj HLSe hwmcn eNlL Hhw Efl fc ab Bjl phQ Seja pWLz Hr jb/im ab fcel pLm
cu cua Bj hqe Llh z)
Date (alM) :
Applicants signature
(BhceLll rl)
FOR OFFICIAL USE ONLY
(Agpl LS hhqll Se)

No. : ___________________Date :_____________

Renewed up to : _____________________
Endorsed as

: _____________________

Consular Officer