sagt: = fr a re fe rs at ea oe GOVERNMENT OF NEPAL Ministry of Foreign Affairs, Department of Passports ePASSPORT APPLICATION FORM Personal Information/=afenata faaeor 4. Sumamelae * SSHRESTHA 2. Given Nemes * RANIIT 3. Place of Bithar=ReTA *DisvctCoutry Abroad) 4. Nationale * Japa NEPAL 5. Date of Birth ft ee/Merih/Oe) 6. Sox * 5A, 80, 1999-11-06 58, 8, | 2054-07-20 Meme, vane wow ow ert woe one Xeronenye 7. Citizenship or Permit Nota ar aya # * 8. Date of sve wean Ft ni * (01017501466 207-027-085 9, Place of Issuers eat ear * 10 National identity No, /aen sfrarey hapa 11 Latest Passport or Travel Document No./ ft perder organ 09925459 AIA. Date of Issue ao/artt art far ¢ = 201 118. Place of lssue/arf we TH Thapa 12. Address/ S47 2A, Province/ tw * Province No. 1 128, Disticufr=a * Jhapa 22€. Rural Municipaity/Municipality | ghadrapur Municip sa ae ira * LE. Street/Village _[PRITHIBINAGAR A2F, House No, wee/ard* ae 13." Emalista 14. Phone No./i= # 4977 9803566966 ity 220. ward No, 02 15, Father's Full name / staat ray * 16. Mother’ Full name / ara aa. * [DEV NARAYAN SHRESTHA CHANDA DEVI PRADHAN 17. Contact details in case of emergency/ eft tar were wi Fear 7A, Fullnamerarae * DEV NARAYAN SHRESTHA 178. Address 17 Provinee/ wen | Province No. 1 170, Distievfaear * hapa 27, Rural Muncipality/Municipalty"gyaqrapur Municipality 17, Ward No, 92 raf ser ra + 176, Sueet/Viloge wes/ars + 18, Email secenenenecnen 19. Phone No. #_O1O5AI5424 sf rn Pera 91 we ae ae a oT ceva ery feet arate emer eh Ere ne sein Pree est af 1 ‘Applicants Signture/ Signature of Guardian, n case of minor PRITHIBINAGAR 17H, House ‘Appointment Details fragaeat aly arareaat waar aferarreat aes Enrollment Center NE, Kuala Lumpur. Date/ Far * — on Date & Time 2025-07-31 11:00 FOR OFFICE USE ONLY. Please fil in the appropriate box with an °" mark patent ‘applicason Type []Reguiar C] emergency Name: new Ep renewat C] oamages [X] tose Sian Document Type Dower (24 Foes [X] rane, (66 Pages} []temorary[] vel Document [oom [Joricst | Saye 2cd9b0a9-447a-4b9a-801a-b273F4470b1a 2cd9b0a9-447a-4b9a-801a-b273F4470b1a