z aera TeTET HATE FEE mre (TT AIT)
afer 6 ans fires
wey ROR RCA A SCAT AT
Information Alteration/Correction cs
6 wera coraeratn crm BSH eas, set cot amma aaa Sar ge CMTE TST AR BOR
‘This form will be used only to change shown information rectify printing errors of the valid passport.
‘ote = axa Beas (CAPITAL LETTERS) “et a or eRe eta IITA AM BT eT MS EST
Instruction : Please fill up the form in ENGLISH (CAPITAL LETTERS) and attach relevant papers in favour of your
application.
“anf tart rfefiecra ara Name of Regional Passport Office/Mission oneceris Frome ret
——-———— ~ a Type of delivery
arent ori
Regular Express
aaa eT fe cam aes a
meee a Payment of Fees
‘Name of Applicant (In Bangla
a : s e z = fea afaatg(vUSs)
aie aa nee) Amount of Fee (w/US!
Name of Applicant (in English) i a
aa im = reefer Te
es Bank/Mission
Received Pessport’s Details =n
Branch
‘“Apicat® «a Passport No. ‘aga ee 6 wiley
i Place & Date of Issue = afta
mle oe
Gea area Sie Date of Expiry if
ft icy : =
EL [ Date
ADIN TERI SPS ST mfaaiSe ARCS oa
Information presently shown in the passport Changed/Corrected information
Date
sion /steeraces (Sima Aisa