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Ng letters - the form cross the boxes where applicable 1. SURNAME (as written in your passport) 2. FULL NAME (as written in your passport) PHOTOGRAPH 35 x 45 mm 3. OTHER NAMES OR SURNAMES USED IN THE PAST 4. DATE OF BIRTH day month year country 5. SEX FOR OFFICE USE ONLY town A male female 6. NATIONALITY present B former (if any) C 7. PERSONAL NUMBER D 8. ADDRESS OF PERMANENT RESIDENCE (country, postal code, town, street, building #, apt #). E F 9. PASSPORT DETAILS type G numb.

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