sagt: 2 fr a rn fe rs a fe 9 an oe GOVERNMENT OF NEPAL Ministry of Foreign Affairs, Department of Passports ePASSPORT APPLICATION FORM Personal Information/=afenarat faaeor 4. Sumamelae * RAL 2. Given Names/ars * SAMMAR 3. Place of Behar * (ist /Country Abroad) 4. Nationaltyaigwat * ¢ Khotang, NEPALL & 5. Date of Birth/ar=t fafa (Year/Month/Day) g 5A, 80, 1989-08-18 5B, BS, 2046-05-02 Flor rom 3 seo eae as a xo : 7. Citizenship of Permit No aria ar args * 8, Date of Issue 8. eanuonrnomnvart FiPt Pm (tmtmen) * 8 1210362! 2065-07-01 3 9, Place of tssuerarét erat kare * 40 National ldentity No, fig sivas 4 a Khotang, 0214059482 2 3 11. Latest Passport or Travel Document No / : AIA. Date of Issue ao raft set fa =x 5 fe ert a ara ays Date of * & 11. Place of Issue/arft Tat Far = 8 12, Address/ 511 8 124 Province/ st *| Province No.1 128. District *|Khotang 22C. Rural Muniipaity/Municipaity pixel Rupakot Majhuwagadhi Municipality 120, Ward No, /7 ara ae ae + ey 126. Street/Vilage [DORPA 12F, House No, vass/erd * wea 13. Emails 14. Phone No./aitw # +97 9862869099 15. Father's Full name /arepit a * 16. Mother's Full name / ar =, * RAM BAHADUR RAL KAMALA RA 17. Contact details incase of emergency/ wef teat were wt fret 7A. Fulinamerarasr * RAM BAHADUR RAL 178. Adsrosstr= 17€.Province/ve* | Province No.1 170. Distietfirert* Khotang, 27€. Rural Muncipalty/Municipalty” Pte Rupakot Majhuwagadhi Municipality 17%, Ward No, 7 mal mente 176. Street/ilage 27H, Howse No, hai DORPA | 38. Emaistiet fevers 39, Phone NOTH safe ein Pee ae #1 it cies sree ee aed a wet aegeTei eel er -ex corner sea fear re ere ee sree eh Pe eet me sree Present Fre erst Ar af 1 Applicant's Signature/ signature of Guardian, incase of minor ‘Apgolntinart Details fragaat aly arareaat waar aferarreat aes Enrollment Center Department of Passports Date/ Fafr © sata ata Date & Time 2023-12-28 11:30 FOR OFFICE USE ONLY ~--¥ Please fil in the appropriate box with an "X" mark seas ‘ropicason ype []Reguar [C] emergency Nana: Li renewat C]oamages [1] tose Sion Document Type [X] orinay (34 Pages) ] ordinary (66 Pases) [] Temporary [_] travel Document [“] ipomstic [Joriest | Oey Lserice 538ad56c-775f -4bb9-bSb0-394c0777f6f3