Embassy of Bangladesh
3510 Internatio nal Dr., NW, Washin gto n, DC, 20008, U SA
TEL- (20 2) 244 0 1 83 , Ext: 115/100
FA X (20 2) 244 7248
W EB - www.bdembassyusa.org
APPLICATION FOR DUAL NATIONALITY
Please note that three (3) sets of the entire
application form including attachments
need to be submitted
Please attach /staple 4 copies of
40mm X 50mm (passport size
photographs) taken within the last
six months (two copies with the first
set and one copy each with the
second and third set. PLEASE DO
NOT USE GLUE.
PLEASE FILL IN THREE COPIES OF THIS FROM. PLEASE TYPE OR PRINT IN BLOCK LETTERS.
UNLESS OTHERWISE MENTIONED, PLEASE COMPLETE ALL ITEMS OR WRITE "N/A" (NOT APPLICABLE) ) IF NEEDED.
1. Name
2. Date of birth
[e. g. 26-Mar-1971]
3. Place of birth (district, in case of Bangladesh)
4. Present address (in the United States)
5. Permanent address (in Bangladesh)
Street
House/Apt #
City
State
Zip code
Home telephone
Cell:
6.a. Name of father
9. Permanent address of father (in Bangladesh)
6.b. Place of birth of father:
7.a. Name of mother
7.b. Place of birth of mother:
8.a. Name of spouse:
8.b. Place of birth of spouse:
10. Name and address of children (Please use separate sheet, if needed)
a.
b.
c.
11. Name and address relatives (living in Bangladesh) who can be contacted for reference (at least one):
a.
Relationsihip
b.
Relationsihip c.
Relationsihip
1
Page - 2
12. Particulars of properties in Bangladesh
with addresss [Please attach separate sheet, if
needed]
13. Date of first leaving Bangladesh
14.a. Bangladesh Passport #
[e. g. 26-Mar-1971]
14.c. Date of issue
14.b. Place of issue
[Please attach photocopy of Bangladesh Passport] [Please attach photocopy of US Passport]
15. Date of acquisition of foreign citizenship
[e. g. 26-Mar-1971]
16.a. Foreign Passport #
[Please attach photocopy of US naturalization certificate]
16.b. Place of issue
16.c. Date of issue
16.d. Date of expiry
[e. g. 26-Mar-1971]
17. Present occupation
[e. g. 26-Mar-1971]
21. Work address
18. Annual income (in US $)
19. Source of income
[Please attach
separate sheet if
needed]
City
State
20. Academic or
special qualification
[Please attach
separate sheet if
needed]
Zip code
Telephone
22. Details of remittance made to Bangladesh [Please attach copies of receipts]
Name of the Bank with address
23. Knowledge of Bangla
Read
Write
Account #
Speak
24. Reasons for seeking citizenship of Bangladesh
25. a. Money order #
25.b.. Issued by
25.c. Amount in US $
Declaration:
I do hereby solemnly affirm and swear that the information provided in this application for dual nationality are true, correct an d complete.
Signature of the ap p lic an t
Date
[e. g. 26-Mar-1971]
FOR OFFICIAL USE ONLY.
Receipt #
Date
Amount (US$)
[e. g. 26-Mar-1971]
Observation of the Mission
Received by
Signature of the issuing authority
Date
[e. g. 26-Mar-1971]
DECLARATION OF ASSETS
(Page 3 of the application set)
1. Name
2. Father's Name
3.a. Description of moveable assets
Description
Quantity/ Number
Value in US $
Quantity (area etc.)
Value in US $
3.b. Description of immoveable assets
Description
Nature of asset
I do hereby solemnly affirm and swear that the information provided above are true, correct and complete.
. Date
e. g. 26-Mar-1971
Signature of the applicant
STATEMENT OF ACTIVITIES IN THE LAST 5 YEARS
(Page 4 of the application set)
1. Name
2. Father's Name
3. Description of activities
Description of Activities (Education/service/business)
From
I do hereby solemnly affirm and swear that the information provided above are true, correct and complete.
Date
e. g. 26-Mar-1971
Signature of the applicant
To
AFFIDAVIT FOR DUAL NATIONALITY CERTIFICATE
(Page 5 of the application set)
I, ( name)
Son of
Daughter of
Present address (in the United States)
Spouse of
Permanent address (in Bangladesh)
Street
House/Apt #
City
State
Zip code
Present occupation:
do hereby solemnly affirm and swear that the information provided in my application for dual nationality are true, correct and
complete.
In witness whereof, I have signed this affidavit before the
Minister
Counselor/
Notary Public
First
Secretary
on the
day of
Signature of the deponent
(Applicant)
The deponent
has signed in my presence.
Signature of Embassy Official or Notary Public
Instruction and Requirements for Dual Nationality application
Application seeking Dual Nationality should be submitted in the prescribed Form (three
sets).
Following may be noted during submission of the application form:
a)
If the applicant is a person temporarily residing in Bangladesh, the application
shall be submitted directly to the Government of Bangladesh (Ministry of Home
Affairs);
b)
If the applicant lives in a foreign country, the application should be sent through
the Bangladesh Diplomatic Mission/ Consulate to that country; and
c)
Where there is no Bangladesh Mission or Consulate in a country of applicant’s
residence, the application may be sent through Bangladesh Mission or Consulate
in the country nearest to that country.
Each application set shall be accompanied by:
1.
Affidavit affirming the truth of the statement made in the application and signed
before the Minister/Counselor/First Secretary / Notary public/ or persons of
equivalent status of the Embassy of Bangladesh in W ashington DC (please see
page 5)
2.
Documentary evidence regarding remittances to Bangladesh for last 3 years.
3.
Copy of foreign citizenship certificate or Naturalization Certificate
4.
Declaration of assets (Movable / Immovable) in Bangladesh (please see page 3).
If required please use a separate sheet. Statement of Parent's assets should be
given if the applicant does not have any asset in his /her name.
5.
Statement of activities for past 5 years (service, education, business etc.) since
first departure from Bangladesh (Please see page 4). Please use separate sheet
if required.
6.
4 color recent passport size photograph (print name on the back )
7.
Fee: Money order of certified check of the amount of US 77.00 payable to the
Embassy of Bangladesh.
8.
Copy of Birth Certificate of children born in the USA (if she/he is the applicant).
9.
Copy of Parent's Bangladesh Passport (page 1-7) or Dual Citizenship Certificate
in the case of child applicant born in the USA.
10.
Photocopy of Bangladesh passport page (1-7).