Schedule – 2
(Related to Sub-rule(1) of Rule 7)
Government of Nepal
Ministry of Foreign Affairs, Central Passport Office
PASSPORT APPLICATION FORM
Please fill in each box with one character and leave an empty box for space. Use only
CAPITAL letters.
Personal Information.
1. Surname :
2. Given Names :
3. Place of Birth : 4. Nationality :
5. Date of Birth :
5A. A.D. 5B. B.S. 6. Sex :
7. Citizenship or Permit No. : 8. Date of Issue B.S. (Year/Month/Day) :
9. Place of Issue : 10. Old Passport or Travel Document No. :
10A. Date of Issue A.D. : 10B. Place of Issue :
11. Address : 11A. District :
11B. Municipality/VDC : 11C. Ward No. :
11D. Town/Village : 11E. House No. :
12. Email : 13. Phone No. :
14. Next of Kin :
14A. Fullname :
14B. Address :
14C. District :
14D. Municipality/VDC : 14E. Ward No. :

14F. Town/Village : 14G. House No. :
15. Relationship : 16. Phone No.
17. Email :
Thumb Impression
Applicant’s Signature : Date : ……………..
Verifying Officer
Name & Signature : ……………………….
Designation: ……………… Date : ……………..

FOR OFFICE USE ONLY
Please fill in the appropriate box with an “X” mark. Validity Application Source & Name Name years Months
CPO District Mission Revenue Receipt No

Application Type Regular Emergency New Lost Renewal Date
Document Type Ordinary Diplomatic Official Travel Document Year Month Day