DEPARTMENT OF IMMIGRATION & EMIGRATION

/ FORM K IM 35 / Affix the third photograph here

APPLICATION FOR A SRI LANKAN TRAVEL DOCUMENT

/ ISSUED FREE
INSTRUCTIONS ON HOW TO FILL THE APPLICATION ARE GIVEN IN PAGE THREE.
(01) Present travel document number / FOR OFFICE USE ONLY
(02)Personal identity card number
(03)Type of travel document
required / All Countries / AC
Specified (Middle East) Countries / ME
Emergency Certificate / EC
Identity Certificate / IC
(04) Surname
(05) Names other than
surname
(06) Civil status / Single / S
Married / M
Divorced / D
Widowed / W
(07) Sex / Male / M
Female / F
(08) Maiden name
(09)
(10) Profession/Occupation
(11) Skin complexion / Black / B / (12) Colour of eyes / Black / 1
Dark / D / Blue / 2
Fair / F / Brown / 3
White / W / Yellow / 4
(13) Colour of hair / Black / 1 / (14) Height in centimeters
Blue / 2
Grey / 3
(15) Marks of identification (if any)
(16) Date of birth / Day / Month / Year
(17) Birth certificate no. and the district
(18) Place of birth
(19) Have you obtained citizenship of a foreign country or dual citizenship in Sri Lanka / Yes
No
(20) Number of children under 16 years of age to be included as per form IM 35 C (Maximum six)
(21) Passport required on / Same day service
Normal service / S
N

Signature of the applicant

DECLARATION OF THE APPLICANT

I declare that/ I am a citizen of Sri Lanka/ I hold Dual Citizenship of Sri Lanka/ I am a citizen of …………………………………... (write the name of the country).*

I declare that the information furnished in this application is true and correct to the best of my knowledge and belief.

I certify that all previous Passports, Emergency Certificates and Identity Certificates held by me have been surrendered to the Sri Lankan Passport Authorities for cancellation, other than the Passport/Emergency Certificate/Identity Certificate No. ………………………… which is now submitted and that I have made no other application since the one attached was issued to me. *

I certify that I have not previously held or applied for any Passport, Emergency Certificate or an Identity Certificate. *

I certify that affixed photographs are depicting the natural status of myself without disguise or concealment and were taken within the last three months.

I certify that the documents attached to this application are true and correct and no alternations, modifications or falsifications were carried out to them to hide or deflect true facts.

Date: …………………..………………………………………

Signature of the applicant

* Please delete inapplicable words.

CERTIFICATE REGARDING THE APPLICANT (NO FEE IS CHARGEABLE FOR THIS CERTIFICATE)

I …………………………………………………………………………………………. of …………………………….

…………………………………………………………………………………………… hereby certify that I have personally known the applicant ………………………………………………………………………….. for a period of …………………………. years and I can, from my personal knowledge of the applicant, vouch for the applicant as a suitable person to receive a Sri Lankan travel document.

To the best of my personal knowledge and belief, the information given by the applicant is true and the declaration made above by the applicant is accurate.

The applicant placed his/her usual signature before me on ………………………………. at ……………………………….

Designation or profession: ………………………………..……………………………..

Signature of the attester

Seal/Stamp/Frank

Please Note:

(1)Persons signing this certificate of attestation should note that they can sign only on the personal knowledge about the applicant.

(2)The above certification could be given only by a Civil List Officer of the Sri Lankan Government, Justice of the Peace, Qualified Medical Practitioner or by an Attorney at Law.

FOR OFFICE USE ONLY

POST PRODUCTION REPORT
Photographs, personal identity card, birth certificate checked and tallies with the details on the passport.
…………………………………………..
Date: …………………………… Signature of checking officer

ISSUING INFORMATION
(1)Despatched by Registered post by
Date:
(2)Handed Over to Applicant by
.

DEPARTMENT OF IMMIGRATION AND EMIGRATION

PHOTO/SIGNATURE CARD

Date : ......

Signature of the attester

FOR OFFICE USE ONLY
Approved / Fee collected / Amount / Receipt number / Passport type
Scanned / Printed / QA

(TO BE COMPLETED WITH ONE PHOTOCOPY)

(PARTICULARS TO BE FURNISHED BY AN APPLICANT WHO HAS

LOST/ DAMAGED HIS/HER PASSPORT)

APPLICATION FOR SRI LANKA PASSPORT

  1. Surname …………………………………………………………………………………
  2. Other names …………………………………………………………………………….
  3. Address in UK …………………………………………………………………………..
  4. Date of Birth………………………….. Place of Birth ………………………………..
  5. Father’s Name ……………………………………………………………….…………
  6. Father’s place of birth and date of birth ……………………………………………….
  7. National Identity Card No: ……………………………………………………………
  8. The Number of the lost passport ………………………………………………………

Date of Issue …………………………. Place of Issue …………………….…………

  1. Details of any previous passports held …………………………………….………….
  2. Permanent address in Sri Lanka………………………………………………………… ……….……………………………………………………………………………………………………………………………………………………………………………
  3. Date of leaving Sri Lanka for the first time ……………………………………………
  4. Details of subsequent visits to Sri Lanka :

YearPeriod of Stay

………………..………………………………….

………………..………………………………….

  1. Amount of foreign exchange taken out from Sri Lanka and in what year.

…………………………………………………………………………………………

14. Present Employment ………………………………………………………………….

15. Period of present Employment .………………………………………………………..

  1. Present monthly income ………………………………………………………………..
  2. Previous employment abroad, if any …………………………………………………..

………………………………………………………………………………………….

  1. Previous employment in Sri Lanka if any ……………………………………………..

………………………………………………………………………………………….

  1. Name and address of the person who signed your security bond (previously)

……………………………………………………………………………….

………………………………………………………………………………

  1. Name and Address of a person who will sign a security bond for the present passport in lieu of the lost passport …………………………………………. …………………………………………………………………………………
  2. Name and Address of a person in Sri Lanka, who will give information regarding you. …………………………………………………………………………………………
  3. Have you informed the local Police regarding the loss of passport, if so when and where:……………………………………………………………………………………
  4. Give briefly the circumstances under which the passport was lost /damaged /stolen …………………………………………………………………………………………
  5. Do you hold any Travel Documents issued by the Immigration and Nationality Department or any other Authority? If so give –

No: …………………………………….. Date of Issue:……………………………….

Give details of visa /work permit etc ………………………………………………….

…………………………………………………………………………………………

  1. What is your visa status? Please attach documents in proof ……………………………..

………………………………………………………………………………………….

  1. Do you intend visiting Sri Lanka in near future, if so when …………………………….
  2. What countries do you intend to visit …………………………………………………..
  3. Have you applied for / obtained nationality of any other country………………………

…………………………………………………………………………………………

I DECLARE THAT THE INFORMATION GIVEN IN THIS APPLICATION IS CORRECT TO THE BEST OF KNOWLEDGE AND BELIEF.

……………………………… Signature of Applicant

Date :…………………………….

(NOTE: SUBMISSION OF FORGED DOCUMENTS SUCH AS THE BIRTH CERTIFICATE OR THE NATIONAL IDENTITY CARD AND MAKING FALSE DECLARATIONS RELATING TO THE CITIZENSHIP STATUS IS AN OFFENCE AND NO REFUND OF FEES IS POSSIBLE IN SUCH INSTANCES)

STATUTORY DECLARATION

I,……………………………………………………………………………………….

of …………………………………………………………………………………………….

do hereby solemnly and sincerely declare as follows:

  1. I am a citizen of Sri Lanka and the holder of Sri Lanka,

Passport No: ……………………….. issued at ………………….. on …………………………..

  1. I have not acquired voluntarily or through the operation of Law, the nationality of any other foreign country, nor have I applied for such foreign nationality.
  2. I have not travelled out of United Kingdom since my passport expired/ lost/ damaged.

I MAKE THIS SOLEMN DECLARATION CONSCIENTIOUSLY BELIEVING THE SAME TO BE TRUE, AND BY VIRTUE OF THE PROVISIONS OF THE STATUTORY DECLARATION ACT 1935.

………………………………….

Signature of Declarant

Declared at ………………………………

This ……………………………….day of ……………………….2000

Solicitor’s name & address ……………………………….

……………………………… Before me

……………………………… (Signature of Solicitor)

………………………………

………………………………

PLEASE FILL IN BLOCK CAPITALS

Date :

Immigration & Nationality Department

Nationality Division

3 rd Floor, India Building,

Water Street,

Liverpool.

L2 0QN.

Dear Sirs,

Please be good enough to inform me as early as possible to my address given below whether I have been granted British Citizenship either by naturalization or by registration. I urgently need the above confirmation in order to renew my Sri Lanka passport.

Forenames ……………………………………………………………………………

Surname ……………………………………………………………………………..

Name at Birth / Nee Name ………………………………………………………….

Address: …………………………………………………………………………….

……………………………………………………………………………

…………………………………………………………………………..

Date of Birth : ………………. Place of Birth- Town/Country ……………………

Passport No: ………………………………………………………………………….

Any other Ref. No: …………………………………………………………………..

Yours faithfully

……………………………..

Signature

I also declare that I am a citizen of Sri Lanka and have not acquired citizenship of the United Kingdom or any other country either by naturalisation or by registration.

…………………………………