Bet, TEN = Qa (irr 8 a aairan | ae afar C Government of Nepal Ministry of Foreign Affairs, Department of Passport PASSPORT APPLICATION FORM Please fil in each box wth one character and loave an empty box for space. Use only CAPITAL letters (ow aratins ee rere wa me vara) ar arereu HeceaT | eet Rone emf wer aa Be eet Personal Information/eateraa faacur 1. Surnamera * BASNET 2, Given Names * Si AGREORIAl 3. Place of aian/areara * 4, Nationality * DANG NEPALESE 5. Date of Brovarm Tit 6. Sexfire* "Kars 8710601 2 Res 264406 28 Fr emeter 2. liznahip or Pert Noonan arate + Mialous one te aaoer ar eased 4300 20610704 9. Place of lssuerarél HES ears * Ta See ahaa Genin eme Ne DANG 410A. Date of Issue ADJ seat fais £1 108, Place of lasuesatit set mart 11, Address HA Disticut=t*) DAN G Wwedraray’ TUL S IT PUR Me. Mave, @ 6 emacs DIPNAGAR Te. Homie a 6 12, Emails basnetsaroja@yahoo. com 18, Phone Nova 9849179070 44,Next of Kinistieer wear mae a4 faareas afte Va. Fullname DEEP BASNET 148, Aadress/2ar=1 140. Disvievinen DOAN G Veena’ TUL ST PUR ME. Ward, @. g ‘tome? DI PNAGAR 146. HaseNo 4 15, Rolaionshiptrar* 16. Phone Nova BROTHER 9841441024 ‘7 Emaivet _deepbasnet@hotmail.com GY, Siyy Sey. Par ren waren wore ates eH em seat ‘Thumb impression’tzrat ara + 7 Applicant's Signatureaeaait 7 * Datei »._ 20140603 ey Venting Ofiear Name & Signature aE Ta neal z "Date FOR OFFICE USE ONLY Wn ‘Vals Please fill n the appropriate box with an °X" mark. ‘Application Source & Name Name a Tir Toor [7] pistrict (~] mission TIT IT IT IIT mmr |J_ Rewertue ReceiptNo.