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 W002065171 PLEASE PASTE
Applicant Name DAVID KATUMWA SEBATINDIRA DO NOT STAPLE
Date Of Birth Nov. 16, 1974 THE PHOTO SHOULD BE
Telephone Number +256705542078 COLOURED WITH A WHITE
Email sebatindira.david@yahoo.com BACKGROUND
NIN CM74023100NK6D

Signature

Type of Passport Ordinary

Type of Application Renewal
Priority Express
Place of Submission Central O�ce Kampala
Place of Collection Central O�ce Kampala
PAYMENT DETAILS
Assessment Date 23/11/2022
Bank Name Stanbic

Description PRN Amount

Passport Ordinary (48 Pages) 2230005364021 250,000

Fee For Express Processing Of Passport 2230005364022 150,000

TOTAL TO PAY 400,000

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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 W002065171
Applicant Name DAVID KATUMWA SEBATINDIRA
Date Of Birth Nov. 16, 1974
Telephone Number +256705542078
Email sebatindira.david@yahoo.com
NIN CM74023100NK6D

Signature

Type of Passport Ordinary

Type of Application Renewal
Priority Express
Place of Submission Central O�ce Kampala
Place of Collection Central O�ce Kampala
PAYMENT DETAILS
Assessment Date 23/11/2022
Bank Name Stanbic

Description PRN Amount

Passport Ordinary (48 Pages) 2230005364021 250,000

Fee For Express Processing Of Passport 2230005364022 150,000

TOTAL TO PAY 400,000

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THE APPLICATION
Passport Type Ordinary
Type of Application Renewal
Priority Express
Place of submission Central O�ce Kampala
Old Passport B1657420
Place of issue KAMPALA
Date of issue May 23, 2018
Date of expiry May 23, 2028
THE APPLICANT
Personal details
Surname SEBATINDIRA
Given name DAVID KATUMWA
Maiden name
Other Names
Telephone Number +256705542078
National Identi�cation Number (NIN) CM74023100NK6D
Card No 00015350
Sex Male
Date Of Birth Nov. 16, 1974
Marital Status Single
Place of Birth LUWEERO
Profession/Occupation Other
Email sebatindira.david@yahoo.com
Residential Address
Country of residence Uganda
District KAMPALA
County/Municipality KAMPALA CENTRAL DIVISION
Sub county KAMPALA CENTRAL
Parish/Ward NAKIVUBO
Village (LC1/Zone) REMAND B
Plot number
If out of Uganda state address
Details of origin
Nationality Uganda
District LUWEERO
County/Municipality KATIKAMU COUNTY SOUTH
Sub county KATIKAMU
Parish/Ward TWEYANZE
Village (LC1/Zone) LUKYAMU
Plot number
Applicant's tribe Baganda
Give details of clan/generation of origin NSENENE
First Descendant NAKYA MIRIAM
Second Descendant KANYEREZI FREDRICK
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 KANYEREZI
Father given name FREDRICK
National Identity Number (NIN)
Date of birth (DD/MM/YYYY) March 3, 1936
Country of Birth Uganda
Place of Birth LUWEERO
Country of Residence Uganda
If out of Uganda state address
District LUWEERO
County/Municipality KATIKAMU COUNTY SOUTH
Sub county KATIKAMU
Parish/Ward TWEYANZE
Village (LC1/Zone) LUKYAMU
Plot number
Fathers's tribe Baganda
Nationality UGANDAN
Mother's details
Mother Status Alive
Mother surname NANKYA
Mother given name ALEXANDRIA
Mother maiden name MIRIAM
National Identity Number (NIN)
Date of birth (DD/MM/YYYY) April 29, 1938
Country of Birth Uganda
Place of Birth LUWEERO
Country of Residence Uganda
If out of Uganda state address
District LUWEERO
County/Municipality KATIKAMU COUNTY SOUTH
Sub county KATIKAMU
Parish/Ward TWEYANZE
Village (LC1/Zone) LUKYAMU
Plot number
Mothers's tribe Baganda
Nationality UGANDAN
NEXT OF KIN

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Contact surname LUUTU
Contact given name ISAAC
Phone number +256782686131
Email luutuisaac4@gmail.com
District KAMPALA
County/Municipality MAKINDYE DIVISION WEST
Sub county MAKINDYE DIVISION
Parish/Ward LUKULI
Village (LC1/Zone) SANKARA
Plot number
Relationship -- other --
Speci�c Relationship SON
NIN CM9403210AV1XD
Passport number
Place of work (organization and physical address SANLAM LIFE INSURANCE
If out of Uganda state address
RECOMMENDER
Recommender surname LUUTU
Recommender given name ISAAC
Profession/Occupation Other
Other Occupation INSURANCE
Address KAMPALA
NIN CM9403210AV1XD
Phone +256782686131

Signature

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

Signature

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

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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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