Travel Agency Agent

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Bank or Travel Agency

Serial number of Seal of Bankor

Date Exchange Control} Amount Travel Agent issuing

Application Forms Issued Foreign Exchange

Relationship

4

{pri wea argues = cer anh sent ff + 2ATT/ Old Travel Document No, with Date and Place of Issue

MACHCHHEGOUN, 05 MACHCHHEGOUN, KATHMANDU

_ 3799416 16 NOV 2007 KATHMANDU

‘rezam atin? Next of Kin

HARI BHAKTA DESHAR

en

BROTHER

Sera) Address

MYS00135295

a1) Ref. No.

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cust t/ Passport No.

09405656

‘ayaReeat i Citizenship No.

29017

‘EHENT/ Place of Birth

KATHMANDU

‘art a4 frera/ Issuing Authority

MOFA, DEPARTMENT OF PASSPORT

‘nc#s8l a8/ Holder's Signature

pur aourisisse ce “1944 40 wuly puoye 02 pur 2duE,puly Jo 39] no\sIM.

‘hyo. ssed 02 4apjoy ap Moje 02 Usaruo> AoW 31 WoYs souinbod

pue sisanbau ‘edany Jo 2uewiutencd ‘sureyy UBio104 jo Kasiulyy 3YL

aura NEPAL

‘ue ##t/ Country Code

NPL

NEPALESE

= feit/ Date of Birth

21 JUN 1986

faa/ Sex

M

are wf frft/ Date of Expiry

17 DEC 2025

ser Type

sey Surname

DESHAR

a1a/ Given Names:

BIRBHAKTA

‘agTa/ Nationality

art fufty/ Date of Issue

18 DEC 2015

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