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 W002071714 PLEASE PASTE
Applicant Name CHRISTOPHER ASIIMWE DO NOT STAPLE
Date Of Birth Dec. 15, 1997 THE PHOTO SHOULD BE
Telephone Number +256756925253 COLOURED WITH A WHITE
Email christopherasiimwe58@gmail.com BACKGROUND
NIN CM9701010HX51D

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 28/11/2022
Bank Name Centenary Bank

Description PRN Amount

Passport Ordinary (48 Pages) 2230005539928 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 W002071714
Applicant Name CHRISTOPHER ASIIMWE
Date Of Birth Dec. 15, 1997
Telephone Number +256756925253
Email christopherasiimwe58@gmail.com
NIN CM9701010HX51D

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 28/11/2022
Bank Name Centenary Bank

Description PRN Amount

Passport Ordinary (48 Pages) 2230005539928 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 ASIIMWE
Given name CHRISTOPHER
Maiden name
Other Names
Telephone Number +256756925253
National Identi�cation Number (NIN) CM9701010HX51D
Card No 021323081
Sex Male
Date Of Birth Dec. 15, 1997
Marital Status Single
Place of Birth BUHINGA HOSPITAL,FORTPORTAL
Profession/Occupation Health Sciences
Email christopherasiimwe58@gmail.com
Residential Address
Country of residence Uganda
District KABAROLE
County/Municipality FORT PORTAL MUNICIPALITY
Sub county SOUTHERN DIVISION
Parish/Ward KIJANJU
Village (LC1/Zone) KATUMBA A
Plot number
If out of Uganda state address
Details of origin
Nationality Uganda
District KABAROLE
County/Municipality FORT PORTAL MUNICIPALITY
Sub county SOUTHERN DIVISION
Parish/Ward KIJANJU
Village (LC1/Zone) KATUMBA A
Plot number
Applicant's tribe Batoro
Give details of clan/generation of origin MUCHWAMBA
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 Alive
Father surname BAGUMA
Father given name CHARLES
National Identity Number (NIN) CM65010102AGTK
Date of birth (DD/MM/YYYY) March 3, 1965
Country of Birth Uganda
Place of Birth KITEBI
Country of Residence Uganda
If out of Uganda state address
District KAMPALA
County/Municipality RUBAGA DIVISION SOUTH
Sub county RUBAGA DIVISION
Parish/Ward MUTUNDWE
Village (LC1/Zone) KITEBI
Plot number
Fathers's tribe Batoro
Nationality UGANDAN
Mother's details
Mother Status Alive
Mother surname ASIIMWE
Mother given name ROSE
Mother maiden name MARY
National Identity Number (NIN)
Date of birth (DD/MM/YYYY) Aug. 10, 1972
Country of Birth Uganda
Place of Birth FORTPORTAL
Country of Residence Uganda
If out of Uganda state address
District KABAROLE
County/Municipality FORT PORTAL MUNICIPALITY
Sub county SOUTHERN DIVISION
Parish/Ward KIJANJU
Village (LC1/Zone) KATUMBA A
Plot number
Mothers's tribe Batoro
Nationality UGANDAN
NEXT OF KIN

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Contact surname BUSINGYE
Contact given name DAVID
Phone number +256785522428
Email davidbusingye@gmail.com
District KAMPALA
County/Municipality RUBAGA DIVISION SOUTH
Sub county RUBAGA DIVISION
Parish/Ward
Village (LC1/Zone)
Plot number
Relationship Brother
Speci�c Relationship
NIN CM8801010FHU1C
Passport number
Place of work (organization and physical address BUSINESS MAN IN KAMPALA METROPOLITAN
If out of Uganda state address
RECOMMENDER
Recommender surname BUSINGYE
Recommender given name DAVID
Profession/Occupation Business Studies
Other Occupation
Address KAMPALA
NIN CM8801010FHU1C
Phone +256785522428

Signature

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

Signature

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