Immigration.go.tz

Fomu CT 5(Ai)
(Revised 2004)
Serial No.
JAMHURI YA MUUNGANO WA TANZANIA
OMBI LA PASIPOTI
MWOMBAJI
SAINI YA MWOMBAJI MBELE YA
DOLE GUMBA LA KUSHOTO
OFISA WA KAUNTA
LA MWOMBAJI MBELE YA
OFISA WA KAUNTA
ADA: - TSh. 50,000/= Au USD 50 (Kwa Walio Nje ya Nchi)
KWA MATUMIZI YA OFISI TU
Namba ya Ombi : Kaunta Na: Tarehe :
Kisio la Tarehe ya Kuchukua :
liyepokea Ombi :
Jina la Ofisa A
MWOMBAJI
Cheo: Saini:
Jalada Na:
TAFADHALI SANA KABLA YA KUJAZA FOMU HII, SOMA
UKURASA WA TATU (3) KWA MAELEZO MUHIMU

1. FOMU IJAZWE KWA HERUFI KUBWA
HABARI BINAFSI
Jina la Ukoo …………….…….…………………. Jina la Kwanza ……………………………….….… Jina la Kati…….………………….……….……… Tarehe ya Kuzaliwa…………….….…….…… Mwezi ….………….….….… Mwaka ….……. Mahali pa Kuzaliwa Kijiji/Mtaa ………………………………….… Wilaya …………………………… Mkoa ….……………….………….…. Nchi ……………….…. Raia wa Kujiandikisha: Shahada Na. ………………….…. Mahali Ilipotolewa ………….………….… Tarehe ya Kujiandikisha ……….…… Mwezi …….……. Mwaka …….….… Kazi ………………………………………………………………………………….…………………. Jina la Zamani ………………………………………………………………………………………….…. Anwani ya Posta ………………………………….… Simu ………………………………………. Barua Pepe ………….……………………………. Faksi …………………………….…….…. Mahali Unapoishi, Mtaa/Kijiji …………………………….…….……… Nyumba Na. ……….………. Wilaya………………………….….……….….…. Mkoa………………………….……….….…. 2. HABARI ZA WAZAZI
Kijiji/Mtaa…….…….…………… Wilaya …………….….…… …………………….…………………… Mkoa …….……………….…….… Nchi ……….……….….…. Tarehe …….…….… Mwezi ……………. Mwaka ………….… Mahali Ilipotolewa ………………………………….………….…… ………………….……….………….…. Tarehe …….…….… Mwezi ……………. Mwaka ………….… …………………………….……………. Kijiji/Mtaa .……………….……. Wilaya ………………………. Mkoa ……………………………… Nchi …………………………. Tarehe …….…….… Mwezi ……………. Mwaka ………….… Mahali Ilipotolewa …………………………………………………. ………………………………………. Tarehe …….…….… Mwezi ……………. Mwaka ………….… 3. Madhumuni ya Safari …………………………………………………………….……………………
Nchi Unazokwenda ………………………………………………………………….………….…… TAMKO RASMI

Mimi niliyetia saini hapa chini, naomba kupewa pasipoti kwa madhumuni hayo niliyoeleza hapo juu Mimi sikupata kuomba wala sijawahi kuwa na Pasipoti ya namna yoyote kabla. C. Nilikuwa na Pasipoti Na. ………………. ambayo imekwisha muda/imepotea/imejaa/imeibwa Habari zilizotajwa katika fomu hii ya ombi kadiri nijuavyo na kuamini ni za kweli, kweli tupu Jina Kamili ……………….……………………………………….…………………………………….
Saini …………………………………….….… Tarehe ….….… Mwezi …….…. Mwaka ….….… ANGALIA: Ikiwa umewahi kuwa na Pasipoti ambayo imeisha/imejaa/imepotea/imeibwa,
futa B na ujaze fungu la 4 hapa chini.
4. TAARIFA YA PASIPOTI YA ZAMANI
Na…….………….…. Mahali Ilipotolewa …………….………….………… Tarehe………….…… Sababu zilizofanya isitumike tena …………………………………….……………………………….
5. KUTOA TAARIFA WAKATI WA DHARURA
Ndugu/Rafiki/watakaopewa taarifa wakati wa dharura (Ajali au kifo): (i) Jina Kamili …………………………….….….… (ii) Jina Kamili……….…………………….…… Kazi………………………………………….…… Kazi……….…………….….……………. Anwani ………………………. Simu …….…. Anwani .….….……….….Simu …………. Anapoishi ………………… ……………………. Anapoishi ……….…………………………. Mtaa ……….………….…Nyumba Na. …….…. Mtaa ….….…………. Nyumba Na.………. Uhusiano …………………………………………. Uhusiano ……………….……………………. 6. SHUHUDA KWA MWOMBAJI (Tazama Na. 2 kwenye maelezo muhimu hapo chini)
Jina Kamili ………………………………………………….………………………………….….…… Kazi……………………………………………………………………………………….……….….… Anwani …………………………………………….….…. Simu ……………….……………………. Tamko: Nashuhudia kwamba maelezo katika fomu hii ndiyo maelezo ya mwombaji
Saini ……….………….……… Muhuri ……………….….…………. Tarehe ………….….……… TAHADHARI:
Mwombaji anaonywa kwamba iwapo itathibitika kwamba maelezo aliyotoa ni ya uongo,
hatua kali za kisheria zitachukuliwa dhidi yake.
Malipo unayotoa unapochukua fomu hayatarejeshwa iwapo ombi lako halitakubalika.
7. HATUA ZILIZOCHUKULIWA NA OFISA WA PASIPOTI
………………………………………………………………………………….………………………… …………………………………………………………………………………………………….………. ……………………………………………………………………………………….……………………. …………………………………………………………………………………….………………………. …………………………………………………………………………………….………………………. …………………………………………………………………………………………….………………. Jina Kamili ………………………………….……………………………………………….……………. Saini ya Ofisa wa Pasipoti……………………………………………………………….….…………. Tarehe ……….…………….… Mwezi ……………….….………… Mwaka ……… ….….….…. MAELEZO MUHIMU
HATI ZA KUTOLEWA
Cheti cha Kuzaliwa au Kiapo cha Kuzaliwa cha Mwombaji. Cheti cha Kuzaliwa au Kiapo cha Kuzaliwa cha Mmoja wa Wazazi wa Mwombaji. Cheti cha Uraia kwa waliopata Uraia kwa Tarijisi. Cheti au Kiapo cha Ndoa kwa Wanawake walioolewa na wanaotaka kubadilisha majina. SHUHUDA KWA MWOMBAJI
Ombi lazima lishuhudiwe katika kifungu cha 6 na mmoja wa hawa; Jaji, Kabidhi Wasii, Hakimu,Wakili/Kamishna wa Viapo, akiwa yeye mwenyewe ni raia wa Jamhuri ya Shuhuda anatakiwa aandike nyuma ya nakala moja ya picha ya mwombaji maneno haya. ‘NASHUHUDIA KWAMBA PICHA HII NI SURA YA BWANA/BIBI/BI ………….na
Mwombaji anatakiwa kuleta nakala tano (5) za picha (Pasipoti) zenye rangi ya bluu bahari. 5. Mwanamke aliyekuwa na pasipoti kabla ya kuolewa anaweza kupata pasipoti nyingine mpya VIELELEZO VYA ZIADA VINAVYOTAKIWA KUAMBATANA NA OMBI HILI
ANGALIA UKURASA WA 4.
HATI NYINGINEZO ZINAZOPASWA KUAMBATISHWA KWENYE OMBI
SAFARI ZA BINAFSI
• Uthibitisho wa Shughuli za Mwombaji • Idhini ya Mzazi/Mlezi halali kwa Mwombaji Chini ya Miaka 18 Barua ya Ofisa Mtendaji Kata/ Sheha kwa Wasioajiriwa (B) SAFARI ZA KIKAZI, MIKUTANO, TAMASHA NA KADHALIKA
(C) SAFARI ZA MASOMO
Uthibitisho wa Malipo kwa Wanaojitegemea Idhini ya Mzazi/Mlezi halali kwa Mwombaji chini ya miaka 18 (D) SAFARI ZA MATIBABU
Barua kutoka kwa Daktari Mkuu wa Serikali au SAFARI ZA BIASHARA
(F) SAFARI ZA AJIRA
Uthibitisho wa barua ya Ajira/Mkataba wa Kazi au Barua ya Ofisa Mtendaji Kata/ Sheha wa sehemu anayoishi mwombaji (G) SAFARI ZA MICHEZO
Barua kutoka Chama chochote kilichosajiliwa rasmi kulingana na aina ya michezo na (H) SAFARI ZA KIDINI
(I) SAFARI ZA MABAHARIA
THE UNITED REPUBLIC OF TANZANIA
SECURITY BOND
KNOW ALL MEN BY THESE PRESENTS that we (1)* …………………………………………………………………… …………………………………………………………………………………………………………………………………of ………………………………………………………………………………………….………………………………………. (Hereinafter refereed to as the obligor) and (1)+ ……………………………………………………………………………….………………………………………. and (3)+ …………………………………………………………………………….…………………………………………. of …………………………………………………………Tel: ………………………….……………………………………. (hereinafter referred to as the sureties) are jointly and severally held and firmly bound unto the Government to Tanzania in the sum of …………………………………………………………….of good and lawfully money of the Republic to paid to the said Government, for which payment well and truly to be made we bind ourselves and each and every one of us jointly and severally for and in that whole, our heirs, executors and administrators and every one of them firmly by these presents. Dated this ………………………………………………. Day of ………………………………….………. 20……………. NOW THE ABOVE-WRITTEN OBLIGATION is conditioned to be void if the said obligor and the said sureties or any of them shall on demand pay forthwith to the said Government any expenses incurred (whether under any legal obligation or otherwise) by or on behalf of the said expenses incurred (whether under any legal obligation or otherwise) by or on behalf of the said Government in connection with the detention maintenance medical treatment or convene to any place outside Tanzania ……………………………………………………………………… …………………………………………………. …………………….………………of.……………………………………… …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………. SIGNED by the above bounden obligor in the presence of: (Witness) …………………………………………………………………………. (Address of witness) ……………………………………………………………. ……………………………………………………………………………………. SIGNED by the above bounden first surety in the presence of: (Witness) ………………………………………………………………………… (Address of Witness) ……………………………………………………………. ……………………………………………………………………………………… SIGNED by the above bounden first surety in the presence of: (Witness) ………………………………………………………………………… (Address of Witness) ……………………………………………………………. ……………………………………………………………………………………… NB: This document must be stamped in accordance with the provisions of the Stamp Ordinance. *Name of Immigrant or some person on his behalf. +Names of sureties if required +Name of Immigration: and any dependants who have entered or are intending to enter the Republic

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