Embassy of Bangladesh

3510 International Dr., NW, Washington, DC, 20008, USA

TEL - (202) 244 0183, FAX - (202) 244 2771
WEB - www.bangladoot.org Please note that three (3) sets of the entire Please attach /staple 4 copies of
application form including attachements 40mm X 50mm (passport size
photographs) taken within the last
APPLICATION FOR DUAL NATIONALITY need to be submitted six months (two copies with the first
PLEASE FILL IN THREE COPIES OF THIS FROM. PLEASE TYPE OR PRINT IN BLOCK LETTERS. set and one copy each with the
UNLESS OTHERWISE MENTIONED, PLEASE COMPLETE ALL ITEMS OR WRITE "N/A" (NOT APPLICABLE) ) IF NEEDED. second and third set. PLEASE DO
NOT USE GLUE.

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 spouse: 9. Permanent address of father (in Bangladesh)

6.b. Place of birth of spouse:

7.a. Name of father

7.b. Place of birth of father:

8.a. Name of mother:

8.b. Place of birth of mother:

10. Name and address of children (Please use seperate 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 # 14.b. Place of issue
[e. g. 26-Mar-1971] [Please attache photocopy of Bangladesh Passport][Please attache photocopy of US Passport]

14.c. Date of issue 15. Date of acquisition of foreign citizenship 16.a. Foreign Passport #
[e. g. 26-Mar-1971] [Please attache 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] [e. g. 26-Mar-1971]

17. Present occupation

21. Work address
18. Annual income (in US $)

19. Source of income

[Please attache
separate sheet if City
needed]
State Zip code
20. Academic or
special qualification
[Please attach Telephone
separate sheet if
needed]

22. Details of remittance made to Bangladesh [Pelase attach copies of receipts]

Name of the Bank with address Account #

23. Knowledge of Bangla Read Write 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 and complete.

Date Signature of the applicant

[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 $

3.b. Description of immoveable assets

Description Nature of asset Quantity (area etc.) Value in US $

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 To

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
 AFFIDAVIT FOR DUAL NATIONALITY CERTIFICATE
(page 5 of the application set)

I, (n)ame)

Son of Ddaughter of Spouse of

Present address (in the United States) 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 Counsellor/ Notary Public
on the day of First Secretary

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/Counsellor/First Secretary / Notary public/ or persons of equivalent status of the Embassy
of Bangladesh in Washington 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 38.00 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).