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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:
