Republic of Uganda
Ministry of Internal A�airs
Directorate of Citizenship and Immigration Control
PASSPORT APPLICATION PAYMENT ADVICE FORM (PERSONAL COPY)
Print this form and make payments in the bank then return to the portal to schedule an appointment
APPLICATON DETAILS PASSPORT PHOTO
Application Number W001404496 PLEASE PASTE
Applicant Name MARYSENT ARIYO DO NOT STAPLE
Date Of Birth Jan. 18, 1975 THE PHOTO SHOULD BE
Telephone Number +256782303318 COLOURED WITH A WHITE
Email
[email protected] BACKGROUND
NIN CF76037103FRFC
Signature
Type of Passport Ordinary
Type of Application Renewal
Priority Standard
Place of Submission Mbarara
Place of Collection Mbarara
PAYMENT DETAILS
Assessment Date 28/03/2022
Bank Name Diamond Trust Bank
Description PRN Amount
Passport Ordinary (48 Pages) 2220007568004 250,000
TOTAL TO PAY 250,000
Page 1 of 6
PASSPORT APPLICATION PAYMENT ADVICE FORM (BANK COPY)
Print this form and make payments in the bank then return to the portal to schedule an appointment
APPLICATON DETAILS
Application Number W001404496
Applicant Name MARYSENT ARIYO
Date Of Birth Jan. 18, 1975
Telephone Number +256782303318
Email [email protected]
NIN CF76037103FRFC
Signature
Type of Passport Ordinary
Type of Application Renewal
Priority Standard
Place of Submission Mbarara
Place of Collection Mbarara
PAYMENT DETAILS
Assessment Date 28/03/2022
Bank Name Diamond Trust Bank
Description PRN Amount
Passport Ordinary (48 Pages) 2220007568004 250,000
TOTAL TO PAY 250,000
Page 2 of 6
THE APPLICATION
Passport Type Ordinary
Type of Application Renewal
Priority Standard
Place of submission Mbarara
Old Passport B1401816
Place of issue MBARARA
Date of issue Oct. 20, 2016
Date of expiry Oct. 20, 2026
THE APPLICANT
Personal details
Surname ARIYO
Given name MARYSENT
Maiden name
Other Names
Telephone Number +256782303318
National Identi�cation Number (NIN) CF76037103FRFC
Card No 008609104
Sex Female
Date Of Birth Jan. 18, 1975
Marital Status Widowed
Place of Birth KATONYA
Profession/Occupation Administration and Human Resource
Email [email protected]
Residential Address
Country of residence Uganda
District RUKUNGIRI
County/Municipality RUKUNGIRI MUNICIPALITY
Sub county SOUTHERN DIVISION
Parish/Ward NDORERO WARD
Village (LC1/Zone) KIBIRIZI
Plot number
If out of Uganda state address
Details of origin
Nationality Uganda
District RUKUNGIRI
County/Municipality RUBABO COUNTY
Sub county NYAKISHENYI
Parish/Ward KATONYA
Village (LC1/Zone) NYAKABALE
Plot number
Applicant's tribe Bakiga
Give details of clan/generation of origin OMUHIMBA
First Descendant TUMWIINE FREDRICK
Second Descendant KIRABO MARILYN
CITIZENSHIP
Citizenship By birth
Provide Dual certi�cate number
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Date of issue
Previous or other nationality
Other passport number
State date of renunciation of previous citizenship
SPOUSE
Spouse Surname
Spouse Given name
Maiden names
Date of marriage
Place of marriage
PARENTS DETAILS
Father's details
Father Status Alive
Father surname MAKIRWA
Father given name BANYEZAKYI
National Identity Number (NIN) CM42037103YA8D
Date of birth (DD/MM/YYYY) May 5, 1942
Country of Birth Uganda
Place of Birth KATONYA
Country of Residence Uganda
If out of Uganda state address
District RUKUNGIRI
County/Municipality RUBABO COUNTY
Sub county NYAKISHENYI
Parish/Ward KATONYA
Village (LC1/Zone) NYAKABALE
Plot number
Fathers's tribe Bakiga
Nationality UGANDAN
Mother's details
Mother Status Alive
Mother surname ORAMANYIRE
Mother given name CLAUDIA
Mother maiden name ORAMANYIRE
National Identity Number (NIN) CF48037108C7TH
Date of birth (DD/MM/YYYY) Sept. 8, 1948
Country of Birth Uganda
Place of Birth BUGANDAZA
Country of Residence Uganda
If out of Uganda state address
District RUKUNGIRI
County/Municipality RUBABO COUNTY
Sub county NYAKISHENYI
Parish/Ward KATONYA
Village (LC1/Zone) NYAKABALE
Plot number
Mothers's tribe Bakiga
Nationality UGANDAN
NEXT OF KIN
Page 4 of 6
Contact surname TUMWIINE
Contact given name FREDRICK
Phone number +256773917195
Email [email protected]
District RUKUNGIRI
County/Municipality RUKUNGIRI MUNICIPALITY
Sub county SOUTHERN DIVISION
Parish/Ward NDORERO WARD
Village (LC1/Zone) KIBIRIZI
Plot number
Relationship -- other --
Speci�c Relationship son
NIN CM9903710989DF
Passport number
Place of work (organization and physical address
If out of Uganda state address
RECOMMENDER
Recommender surname ASIIMWE
Recommender given name EDITH MARY
Profession/Occupation Administration and Human Resource
Other Occupation
Address NABWERU SOUTH 1
NIN CF720371017AAE
Phone +256782440598
Signature
ELSE RECOMMENDER
Recommender surname
Recommender given name
Profession/Occupation
Address
NIN
Phone
Signature
PAYMENT
Payment Mode Over-the-counter bank payment
Payment Bank Diamond Trust Bank
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Note
You can pay all PRNs obtained using:
I. Mobile money
II. Cheque
III. Bank over the counter
IV. Point pf Sale
Other payment methods provided by your bank include
I. Electronic funds transfer
II. Real time gross settlement
III. Swift
IV. Online payment (VISA MasterCard, Union pay, American express with : Orient, STANBIC and Barclays Banks)
If you fail to complete the online transaction you can try again later with the online bank option or pay the same PRN
using any other payment option at acceptable banks.
You can use any of the following banks of their choice once you have a PRN
1. Bank Of Africa
2. Bank Of Baroda
3. Bank Of Uganda
4. Barclays Bank
5. Commercial Bank Of Africa Uganda Limited
6. Cairo International Bank
7. Centenary Bank
8. Citibank
9. DFCU Bank
10. Diamond Trust Bank
11. Eco Bank
12. Equity Bank Uganda Limited
13. Exim Bank Uganda Limited
14. Finance Trust Bank Limited
15. Gtbank
16. Housing Finance Bank
17. KCB Bank Uganda
18. NC Bank Uganda Limited
19. Orient Bank
20. Post Bank Uganda Limited
21. Pride Micro�nance Uganda Ltd
22. STANBIC
23. Standard Chartered
24. Tropical Bank Ltd
25. United Bank For Africa
NB: Please ensure to pay your PRN before 21 days expire
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