Fillable Form 5.: em @Jo@clc:l I 8'1T6liraJlS!Jli? 6lli61ffi61l15TUULD 1J

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APPLICATION
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application
must
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the
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I
APPLICATION
NO.
I
ALLOCATED
PASSPORT
NO.
I
AC
CODE
I
N
I I I
,1.
Type
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Service
}
Normal
D
OneDay
D
2. Type
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Travel
Document
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All
Countries
D
Middle
East
D
Emergency
D
Identity
D
Countries
Certificate
Certificate
3.
Present Travel
Document
No.
(If any)
4. NMRP No.
(If any)
I I I I I
5. National
Identity
Card No.
}
6.
Surname
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7.
Other
Names
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8.
Permanent
Address
H I I I
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8.1
District
9.
Date
of
Birth
}
Date
Month
Year
10. Birth
Certificate
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No
.
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11. Place
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I I
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12
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Sex
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Female
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Male
D
13.
Profession/
Occupation/
Job
}
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14.
Have
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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
}
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ign
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a
lity
I
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.
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ign
Pass
port
No
.
I
I
19.
If
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application
is
for
a
child
below
the
age
of
16
years,
following
information
must
also
be
provided.
Father I
Guardian
Mother
I
Guardian
National Ide
ntity
Card
No
. I Present Travel
Document
No
.
National
Identity
Card No. I Present
Tr
avel
Docum
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I I I I I I I I I
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I
declar
e
that
I
am
a
cit
izen
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
s
hable
offenc
e.
Controll
e
r's
Order
Minute
Sheet
Attached
(If any)
DC
I
AC
Signatur
e
Pending
at
Computer
Divi
s
ion
PPT
No
:
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Signatur
e
of
the
Applicant
PPT
Lost:
Yes
/
No
Police
Report
/TTD
I NMRP
Dual
Citizen:
Ye
s I
No
BC
No
. &
District
:
NIC I DL I
Po
s
ta
liD
MC
No
. &
District
F's
PPT
I
NIC
Copy
&
Concent
Letter
M'
s
PPT
I NIC
Copy
&
Conc
e
nt
Lett
er
DC
I AC's
Order
:
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Completed 15 March 2022

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