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 W002946905 PLEASE PASTE
Applicant Name Joan Nanteza DO NOT STAPLE
Date Of Birth July 20, 1995 THE PHOTO SHOULD BE
Telephone Number +256707452196 COLOURED WITH A WHITE
Email BACKGROUND
NIN CF95069103V9GA

Signature

Type of Passport Ordinary

Type of Application Lost
Priority Standard
Place of Submission Central O�ce Kampala
Place of Collection Central O�ce Kampala
PAYMENT DETAILS
Assessment Date 18/01/2024
Bank Name Centenary Bank

Description PRN Amount

Passport Ordinary (48 Pages) 2240010728280 250,000

Fine For Lost Passport 2240010728281 100,000

TOTAL TO PAY 350,000

Page 1 of 6
 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 W002946905
Applicant Name Joan Nanteza
Date Of Birth July 20, 1995
Telephone Number +256707452196
Email
NIN CF95069103V9GA

Signature

Type of Passport Ordinary

Type of Application Lost
Priority Standard
Place of Submission Central O�ce Kampala
Place of Collection Central O�ce Kampala
PAYMENT DETAILS
Assessment Date 18/01/2024
Bank Name Centenary Bank

Description PRN Amount

Passport Ordinary (48 Pages) 2240010728280 250,000

Fine For Lost Passport 2240010728281 100,000

TOTAL TO PAY 350,000

Page 2 of 6
THE APPLICATION
Passport Type Ordinary
Type of Application Lost
Priority Standard
Place of submission Central O�ce Kampala
Old Passport A01020161
Place of issue Kampala
Date of issue Feb. 9, 2023
Date of expiry Feb. 8, 2033
THE APPLICANT
Personal details
Surname Nanteza
Given name Joan
Maiden name
Other Names
Telephone Number +256707452196
National Identi�cation Number (NIN) CF95069103V9GA
Card No
Sex Female
Date Of Birth July 20, 1995
Marital Status Single
Place of Birth Kampala
Profession/Occupation
Email
Residential Address
Country of residence Uganda
District NAKASEKE
County/Municipality NAKASEKE SOUTH COUNTY
Sub county NAKASEKE
Parish/Ward KIGEGGE
Village (LC1/Zone) MULUNGI-OMU
Plot number
If out of Uganda state address
Details of origin
Nationality Uganda
District KAMPALA
County/Municipality KAMPALA CENTRAL DIVISION
Sub county KAMPALA CENTRAL
Parish/Ward MENGO
Village (LC1/Zone) RUBAGA ROAD B
Plot number
Applicant's tribe Baganda
Give details of clan/generation of origin Ffumbe
First Descendant Walusimbi
Second Descendant Kaweesa
CITIZENSHIP
Citizenship By birth
Provide Dual certi�cate number

Page 3 of 6
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 Ndugga
Father given name Edward
National Identity Number (NIN) CM73069101X5KC
Date of birth (DD/MM/YYYY) Oct. 30, 1973
Country of Birth Uganda
Place of Birth Kampala
Country of Residence Uganda
If out of Uganda state address
District KAMPALA
County/Municipality KAMPALA CENTRAL DIVISION
Sub county KAMPALA CENTRAL
Parish/Ward MENGO
Village (LC1/Zone) RUBAGA ROAD B
Plot number
Fathers's tribe Baganda
Nationality UGANDAN
Mother's details
Mother Status Alive
Mother surname Najjengo
Mother given name Rosemary
Mother maiden name Mary
National Identity Number (NIN) CF78069104N77J
Date of birth (DD/MM/YYYY) Aug. 12, 1978
Country of Birth Uganda
Place of Birth Kampala
Country of Residence Uganda
If out of Uganda state address
District KAMPALA
County/Municipality NAKAWA DIVISION
Sub county NAKAWA
Parish/Ward BUKOTO I
Village (LC1/Zone) SEMWOGERERE
Plot number
Mothers's tribe Baganda
Nationality UGANDAN
NEXT OF KIN

Page 4 of 6
Contact surname Ndugga
Contact given name Edward
Phone number +256705228699
Email
District KAMPALA
County/Municipality KAMPALA CENTRAL DIVISION
Sub county KAMPALA CENTRAL
Parish/Ward MENGO
Village (LC1/Zone) RUBAGA ROAD B
Plot number
Relationship Father
Speci�c Relationship
NIN CM73069101X5KC
Passport number
Place of work (organization and physical address
If out of Uganda state address
RECOMMENDER
Recommender surname Nambalirwa
Recommender given name Florence male
Profession/Occupation Education
Other Occupation
Address Nabweru
NIN CF90068106X3FD
Phone +256777227407

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

Page 5 of 6
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

Page 6 of 6