ïay evsjv‡`kx bvMwiK‡`i Rb¨ dig bs- 9-30-08B

MYcÖRvZš¿x evsjv‡`k miKvi

Av‡ivnb KvW© Embarkation Card (For Bangladeshi Nationals Only)
1| bvg (®úóv¶‡i) :............................................................................ 2| wj½ : £ cyi“l £ gwnjv
Name (in BLOCK LETTERS) Sex M F
3| wcZv/¯^vgxi bvg :............................................................................
Father’s Husband’s Name
4| †ckv :..................................................................
Profession
5| K) Rb¥ ZvwiL : ...................................................... L) Rb¥ ¯’vb ...............................................
Date of Birth Place & Country of Birth
6| K) cvm‡cvU© bs ....................................................... L) cÖ`v‡bi ¯’vb I ZvwiL ...............................
Passport No Date & Place of Issue
M) †gqv‡`vËx‡b©i ZvwiL ............................................. N) cvm‡cv‡U©i aiY ......................................
Date of Expiry Type of Passport
7| K) wfmv bs ............................................................. L) cÖ`v‡bi ZvwiL .......................................
Visa No Date of Issue
M) wfmv cÖ`v‡bi ¯’vb .................................................. N) †gqv‡`vËx‡b©i ZvwiL ................................
Place of Issue Date of Expiry
O) wfmvi cÖKvi ..............................................................
Type of Visa
8| evsjv‡`‡ki ¯’vqx wVKvbv .....................................................................................................................................................
Permanent Address in Bangladesh
9| d¬vBU bs ................................................................... 10| AeZib ¯’j ....................................................
Flight No Port of Disembarkation
11| cÖ_g we‡`k-ågb wK? £ nu¨v £ bv
Whether first trip in abroad? Yes No
12| we‡`‡k Ae¯’v‡bi wVKvbv .........................................................................................................
Address in abroad

hvÎxi ¯^v¶i ................................. ZvwiL ..........................................

Signature of Passenger Date
____________________________________________________________________________________________
wet `ªt cÖ‡hvR¨ N‡i wUK (P) wPý w`b| Please tick the appropriate box (es)
..........................................................................................................................................................................................
evsjv‡`‡k cÖZ¨veZ©bKv‡j Bwg‡MÖk‡b n¯—vš—i‡hvM¨ To be retained and handed over on return
MYcÖRvZš¿x evsjv‡`k miKvi
AeZiY KvW© DISEMBARKATION CARD
(ïay evsjv‡`kx bvMwiK‡`i Rb¨ For Bangladeshi nationals only)
1| bvg (®úóv¶‡i) :.............................................................. 2| wj½ : £ cyi“l £ gwnjv
Name (in BLOCK LETTERS) Sex M F
3| K) cvm‡cvU© bs ............................................... L) cÖ`v‡bi ¯’vb I ZvwiL ....................................
Passport No Date & Place of Issue
M) †gqv‡`vËx‡b©i ZvwiL .....................................
Date of Expiry
4| cÖZ¨vMg‡bi ZvwiL ............................... 5| d¬vBU bs ....................................
Date of Arrival Flight No
6| †kl Av‡ivnb¯’j (cÖZ¨vMZ hvÎx‡`i Rb¨) ....................................................................................
Port of last Embarkation (for arriving passenger):

hvÎxi ¯^v¶i ZvwiL :.....................

Signature of Passenger Date :

C:\Documents and Settings\admin\My Documents\Embarkation Card.doc

PDF created with pdfFactory Pro trial version www.pdffactory.com