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DEPARTMENT OF IMMIGRATION AND EMIGRATION
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SRI LANKAN IDENTITY OVERSEAS SR I LAN I(A
IMM IGAATION A ND EMIGRATION

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APPLICATION FOR A SRI LANKAN PASSPORT, EMERGENCY/ IDENTITY CERTIFICATE

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The data and information are fed into the computer in English. Hence the application must be filled in English. Please read the instruction sheet for further information.

(d®G'l:kles:>G'l For Official use only

APPLICATION NO. ALLOCATED PASSPORT NO. AC CODE

N
I I I I I I I
,1. Type of Service } Normal
D OneDay D
✘

2. Type of Travel Document } All Countries

D
✘
Middle East
Countries D Emergency
Certificate D Identity
Certificate D
3. Present Travel Document No. (If any) 4. NMRP No. (If any)

I I I I I
5. National Identity Card No.
}
6. Surname
} [ I I I I I I I I I I I I I I I I I I I I I I
7. Other Names
}I I I I I I I I I I I I I I I I I I I I I
8. Permanent Address

H I I I 111111111111111111
8.1 District

9. Date of Birth
} Date Month Year

10. Birth Certificate } No.

I I District

11. Place of Birth } I I I

12. Sex
} Female
D Male
D✘
13. Profession/ Occupation/ Job } I I I
14. Have you obtained Dual Citizenship in Sri Lanka? } Yes
D No
D
✘
If Yes, Dual Citizenship No.
I I I
(Please fill up fields 17 and 18 in the next page)

15. Mobile/ Phone No. (to be notified via SMS when passport is ready for collection) }

16. E-maiiAddress } ambogahawatta2002@gmail.com

 Compulsory for Dual Citizenship Holders

17. Fo reign Nationality

. I I
18. Foreign Passport No.
I I

19. If this application is for a child below the age of 16 years, following information must also be provided.
Father I Guardian Mother I Guardian
Nati o nal Id entity Card No. I Present Travel Document No. National Identity Card No. I Present Travel Document No.

I I I I I I I I I I I I I I I I I I I I I I I I I I
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Applicant, Please place your signature insid e both cag es below. Signature should not touch the border.

21 . 1dl'S>)GDCJI6Ui6lfliTGmuu$!'Jrr1J!fl6riT i!LIDJ$[,lll..J61n1J I Declaration of the Applicant

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I declare that I am a citizen of Sri Lanka and the above information provided by me and the documents attached hereto are true and
correct. Also, I am aware of the fact that producing forg ed/ falsified documents and information is a puni shable offence.

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Signature of the Applicant

Controll er's Order Minute Sheet Attached (If any)

PPT No:

PPT Lost: Yes/ No

DC I AC Signature
Police Report /TTD I NMRP

Dual Citizen : Yes I No

BC No. & District:

NIC I DL I Posta liD

MC No. & District

F's PPT I NIC Copy & Concent Letter

Pending at Computer Division
M's PPT I NIC Copy & Concent Letter

DC I AC's Order: