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: www.bdcgny.org APPLICATION FORM FOR INTERIM BIRTH REGISTRATION NUMBER (IBRN) (PLEASE FILL-OUT THE FORM IN ENGLISH WITH BLOCK LETTERS) Date of Birth: Day: Gender: Month: Year: Male: Female: Full Name: Place of Birth: District: Country: Passport Number: Date of Issue: Day: Month: Year: Place of Issue: Mother’s Name: Mother’s Nationality: Father’s Name: Father’s Nationality: Village / House #: Road # / Ward #: Permanent address: Thana/ Upazila: District: Country: Apartm.

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