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WW) Ics PALS WIT WIADMET
sstime Immigration and Citizenship Service
Alien Passport or ID Card Application Form
eats Rena
[ees
4&PC/Personal ID 4.20 &PC/ File No
' Applicants”
\.FirstName______ Middle Name Last Name
2.Sex___ Nationality Height Color of Eye
3. Color of Hair Date of Birth:Date Month Year
4. Place of Birth country City Specific place
5. Marital Status single[—]Married [7] Divoreed [7] Widowed (]
6. Passport Nq, Issue date:Date Month Year
7. Expiry date: Date Month eanagaace ae
8. Occupation Profession Organization Name
Working Address: Region/City Administration Zone/sub city
Woreda Kebele House No Phone No
Residence Address in Ethiopi
9. Region/city Administration ___Zone/sub city
Woreda Kebele House No____ Phone No
Spouse Detail
10. Husband (___] wie [
LisRiGeNams, Middle Name Last Name
12. Date of Birth : Date, Month __ Year __
13. Place of Birth: Country City___~_ Specific Place
Color of Eye color of hair
14, Height _——
15. Nationality___—-____————
16. Occupation _—_—___*—
Tande1111710208 PH ALLNEC RIT B1S3 owe ttems +25111 1569;
Eas74t nan Mn WIRE ey) Ics PAOLIGHIS WIT AIA
wey aeu: Immigration and Citizenship Service
Alien Passport or ID Card Application Form
Color of Eye Color Of Hair Occupation
Passport No Issue date: Date Month Year
Expiry date: Date Month Year
-Request Type :Alien Passport __|Permanent ID[___| Temporary ID
ETD Number Of Supporting Documents.
Reason for Issue Place of Issue
Valid of Countries 4
First Name Middle Name LastName sex Contact persor/organization
‘Region/City Administration Zonelsub-city Woreda
Kebele House No ‘Phone No
‘There by declare that the information I have supplied in this form is complete, truthful
and correct .
Full Name: Signature
Request Date
List of Supporting documents
| Bacio
2 4251111719223 PF ALSHTC RIMPABE1GS oOLHes +251111569914 AL? www.invea.govet
BAS741 ASD ANI ATPASE
