Fill and Sign the Intervale Center Event Facility Rental Application Form

Affix your both ears exposed 2” x 2” size photo here and provide one for Passport APPLICATION FORM FOR NEPALI PASSPORT/TRAVEL DOCUMENT Embassy of Nepal 2131 Leroy Place, N. W. Washington, D. C. 20008 Permanent Mission of Nepal 820 Second Avenues, Suite 17 B, New York, NY 10017 I, the undersigned, apply for Passport/Travel Document with my following particulars. I will fully comply with the Passport Act, 2024 and Passport Regulations, 2027. 01. Applicant’s full Name (in Nepali and English, block letters) 02. Permanent Address in Nepal: Block no: Nepali: Ward No: Tole/Gaon: Mr./Mrs./Miss: VDC/Municipality: District: Temporary Address (your address in foreign country): Street Address: Apt. no.: City: State: Tel: Zip code: Country: Email : 04. Father’s name: 03. Date of Birth Month Date Year Nationality: B. S. A. D. Ward no: Address: Block no: Tole/Gaon: Municipality/VDC: 05. Place of Birth: Place: 07. Married Country: Single 10. Color of eyes: 08. Male 06.: Nationality: Female Color of hair: Complexion: District: Profession: 09. Guardian’s Name: Relation: 11. If you are a Nepalese government employee, please specify: Height: …….. m. ……. cm. Position: .....ft. .......in Office/Organization: Special peculiarities: 12. Emergency contact address of your next of kin in Nepal: Name: 13. Your Citizenship no.: Relation: Date of issue: VDC/Municipality: Ward no: 14. Your current Passport no: Tole/Gaon: District: District: Date & place of issue: Tel: 15. Please give the following details of the minor and disabled child travelling with you: No. Full Name Date of birth Relation 1. No. Full Name Date of birth 2. I solemnly declared that the information provided above are correct. Signature of the Applicant Date: ………………………………………………. …………………………………………. For official purpose only (please don’t write anything below this line) 1. No. of Passport issued: 2. Type: 3. Date of Issue: 4. Valid until: Regular Official Diplomatic 5. Passport fee in US $: Gratis I have received the above passport: Signature: Date: Relation Requirements for Obtaining Passport / Travel Document Nepali Passport is valid for Ten years from the date of issue. It is non-renewable; thereafter passport holders are required to apply for a new passport well within time before expiry, but not earlier than six months validity period. However, in case of accidental damage of the passport or use of all the pages meant for visa, one could apply for new passport any time. Please note the following and send application accordingly at either one of the following addresses: Embassy of Nepal 2131 Leroy Place, N. W. Washington, D. C. 20008. Tel: 202 667 4550 Fax: 202 667 5534 Consulate General of Nepal 820 Second Avenue, Suite 17 B New York, NY 10017. Tel. (212) 370 3988/89 Fax (212) 953 2038 Passport applicants from New York, New Jersey, and Connecticut States have to apply in the Nepalese Consulate in New York 1. Fill the form in CAPITAL LETTERS. 2. Affix one photograph with both ears exposed (size 2 x 2) on the designated place in the application form and enclose one for passport. Photographs should not be older than six months. 3. Send money order or cashier's check of US $ 80.00 in the name of Embassy of Nepal. If two or more applicants applying together, you may make a single money order or cashier's check multiplying the fee by the number of applicants. PERSONAL CHECKS ARE NOT ACCEPTED. 4. Send your current passport and its copies of page no. 1, 2 and 3. 5. Send a self-addressed strong envelope with sufficient postage to return passport/s. Regular or first class mail has no tracking number to inquire the delivery status. We advise applicants to send prepaid envelope of any kind of express mail to return passport/s. We take no responsibility of any undelivered passport/s because of the insufficient postal charge or a weak envelope to bear up the load. 6. For inclusion of your child's name in your passport, please include additional US $ 25.00 for each child and provide the following in a separate application addressed to the Embassy: (i) full name of the child (ii) sex (iii) date and place of birth (iv) copy of birth certificate (v) two photographs, (size 2"x2") and (vi) copy of father's passport (page no. 1, 2, and 3) as a proof of Nepalese citizenship. Parents may apply for individual passport for their child by filling-out an application form with all the information and documents as mentioned above. A child, whose father is not a citizen of Nepal, is not eligible to obtain Nepali passport. 7. Those, who marry after arrival in foreign country and wish to include husband's family name in the passport, must submit a notarized copy of marriage certificate, or original marriage certificate for the first time. 8. Any amendment or modification of particulars given in the passport can be made only on payment of US $ 25.00 for each such amendment/modification. 9. Passport applicants from New York, New Jersey, and Connecticut States have to apply in the Nepalese Consulate Office in New York ADDITIONAL REQUIREMENT IN CASE OF LOSS OF THE OLD PASSPORT 1. Report to the local police and ask for an acknowledgment or a counter report as a proof and send it to the Embassy or Consulate General. 2. Send copies of page no. 1, 2 and 3 of lost passport and copy of visa issued by the concerned Embassy. 3. Send your original Citizenship Certificate, if not send its copy. 4. If you don't have copy of the lost passport and citizenship certificate, please specify the number of the lost passport and date and place of issue. In such a case, an indefinite time is required to verify records to issue a new passport if the lost passport was not issued by the Embassy or Consulate General indicated above..