Republic of Uganda

Ministry of Internal A�airs

Directorate of Citizenship and Immigration Control

PASSPORT APPLICATION PAYMENT ADVICE FORM (PERSONAL COPY)

Print this form and make payments in the bank then return to the portal to schedule an appointment

APPLICATON DETAILS PASSPORT PHOTO

Application Number W001623768 PLEASE PASTE
Applicant Name RONALD KANSIIME DO NOT STAPLE
Date Of Birth July 7, 1992 THE PHOTO SHOULD BE
Telephone Number +256782167944 COLOURED WITH A WHITE
Email rkansiime4@gmail.com BACKGROUND
NIN CM920341033KQL

Signature

Type of Passport Ordinary

Type of Application New application
Priority Standard
Place of Submission Central O�ce Kampala
Place of Collection Central O�ce Kampala
PAYMENT DETAILS
Assessment Date 06/06/2022
Bank Name Dfcu Bank

Description PRN Amount

Passport Ordinary (48 Pages) 2220009903300 250,000

TOTAL TO PAY 250,000

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 PASSPORT APPLICATION PAYMENT ADVICE FORM (BANK COPY)
Print this form and make payments in the bank then return to the portal to schedule an appointment

APPLICATON DETAILS
Application Number W001623768
Applicant Name RONALD KANSIIME
Date Of Birth July 7, 1992
Telephone Number +256782167944
Email rkansiime4@gmail.com
NIN CM920341033KQL

Signature

Type of Passport Ordinary

Type of Application New application
Priority Standard
Place of Submission Central O�ce Kampala
Place of Collection Central O�ce Kampala
PAYMENT DETAILS
Assessment Date 06/06/2022
Bank Name Dfcu Bank

Description PRN Amount

Passport Ordinary (48 Pages) 2220009903300 250,000

TOTAL TO PAY 250,000

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THE APPLICATION
Passport Type Ordinary
Type of Application New application
Priority Standard
Place of submission Central O�ce Kampala
Old Passport
Place of issue
Date of issue
Date of expiry
THE APPLICANT
Personal details
Surname KANSIIME
Given name RONALD
Maiden name
Other Names
Telephone Number +256782167944
National Identi�cation Number (NIN) CM920341033KQL
Card No
Sex Male
Date Of Birth July 7, 1992
Marital Status Single
Place of Birth RUBAARE
Profession/Occupation Computer & Information Sciences
Email rkansiime4@gmail.com
Residential Address
Country of residence Uganda
District KAMPALA
County/Municipality KAWEMPE DIVISION SOUTH
Sub county KAWEMPE DIVISION
Parish/Ward MAKERERE II
Village (LC1/Zone) ZONE A
Plot number
If out of Uganda state address
Details of origin
Nationality Uganda
District NTUNGAMO
County/Municipality RUSHENYI COUNTY
Sub county RUBAARE TOWN COUNCIL
Parish/Ward RUKIIRI
Village (LC1/Zone) KIBONWA I
Plot number
Applicant's tribe Banyankore
Give details of clan/generation of origin
First Descendant
Second Descendant
CITIZENSHIP
Citizenship By birth
Provide Dual certi�cate number

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Date of issue
Previous or other nationality
Other passport number
State date of renunciation of previous citizenship
SPOUSE
Spouse Surname
Spouse Given name
Maiden names
Date of marriage
Place of marriage
PARENTS DETAILS
Father's details
Father Status Deceased
Father surname SABASTIANO
Father given name KABISAKI
National Identity Number (NIN)
Date of birth (DD/MM/YYYY) June 7, 1964
Country of Birth Uganda
Place of Birth NTUNGAMO
Country of Residence Uganda
If out of Uganda state address
District NTUNGAMO
County/Municipality RUSHENYI COUNTY
Sub county RUBAARE TOWN COUNCIL
Parish/Ward RUKIIRI
Village (LC1/Zone) KIBONWA I
Plot number
Fathers's tribe Banyankore
Nationality UGANDAN
Mother's details
Mother Status Alive
Mother surname ATUHAIRE
Mother given name WINFRED
Mother maiden name SABA
National Identity Number (NIN) CF7003410AQN4L
Date of birth (DD/MM/YYYY) June 22, 1970
Country of Birth Uganda
Place of Birth NTUNGAMO
Country of Residence Uganda
If out of Uganda state address
District NTUNGAMO
County/Municipality RUSHENYI COUNTY
Sub county RUBAARE TOWN COUNCIL
Parish/Ward RUKIIRI
Village (LC1/Zone) KIBONWA I
Plot number
Mothers's tribe Banyankore
Nationality UGANDAN
NEXT OF KIN

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Contact surname KAYONGO
Contact given name ENOCK DENNIS
Phone number +256705568888
Email
District KAMPALA
County/Municipality KAWEMPE DIVISION SOUTH
Sub county KAWEMPE DIVISION
Parish/Ward MAKERERE II
Village (LC1/Zone) ZONE A
Plot number
Relationship Brother
Speci�c Relationship
NIN CM960521074P4J
Passport number
Place of work (organization and physical address
If out of Uganda state address
RECOMMENDER
Recommender surname KAYONGO
Recommender given name ENOCK DENIS
Profession/Occupation Computer & Information Sciences
Other Occupation
Address MAKERERE II
NIN CM960521074P4J
Phone +256705568888

Signature

ELSE RECOMMENDER
Recommender surname
Recommender given name
Profession/Occupation
Address
NIN
Phone

Signature

PAYMENT
Payment Mode Over-the-counter bank payment
Payment Bank Dfcu Bank

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Note

You can pay all PRNs obtained using:

I. Mobile money
II. Cheque
III. Bank over the counter
IV. Point pf Sale

Other payment methods provided by your bank include

I. Electronic funds transfer
II. Real time gross settlement
III. Swift
IV. Online payment (VISA MasterCard, Union pay, American express with : Orient, STANBIC and Barclays Banks)
If you fail to complete the online transaction you can try again later with the online bank option or pay the same PRN
using any other payment option at acceptable banks.

You can use any of the following banks of their choice once you have a PRN
1. Bank Of Africa
2. Bank Of Baroda
3. Bank Of Uganda
4. Barclays Bank
5. Commercial Bank Of Africa Uganda Limited
6. Cairo International Bank
7. Centenary Bank
8. Citibank
9. DFCU Bank
10. Diamond Trust Bank
11. Eco Bank
12. Equity Bank Uganda Limited
13. Exim Bank Uganda Limited
14. Finance Trust Bank Limited
15. Gtbank
16. Housing Finance Bank
17. KCB Bank Uganda
18. NC Bank Uganda Limited
19. Orient Bank
20. Post Bank Uganda Limited
21. Pride Micro�nance Uganda Ltd
22. STANBIC
23. Standard Chartered
24. Tropical Bank Ltd
25. United Bank For Africa

NB: Please ensure to pay your PRN before 21 days expire

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