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™◊ËÕ- °ÿ≈ (Name-surname) ™◊ËÕ NAME
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—≠™“μ‘ (Nationality)...................................................... «—π-‡¥◊Õπ-ªï‡°‘¥ (Date of birth)..................................... Õ“¬ÿ (Age).....................ªï (Years) ‡æ» (Sex) ™“¬ (Male) À≠‘ß (Female) Àπ—ß ◊Õ‡¥‘π∑“߇≈¢∑’Ë (Passport No.)................................ ∑’ËÕ¬àŸ„πª√–‡∑»‰∑¬ (Address)........................................ ....................................................................................... Õ”‡¿Õ.................................®—ßÀ«—¥.................................