Personal Information

First Name (like in the passport) *
Last Name (like in the passport) *
Father's Name (like in the passport)
Gender *
Date Of Birth (like in the passport) *

Permanent Residence Information

Country Of Residence *
Citizenship *
Ethnic Origin *
If Your Ethnic Origin not Listed. Please type your Ethnic Origin
Region Of Permanent Residence (For Citizens Of Uzbekistan)

English Proficiency Information

English Proficiency Test Taken or Registered for (IELTS, TOEFL, Other) *
Overall Band Score (if available)
Entered value should be number or empty string
Writing Component Score (if available)
Entered value should be number or empty string
Reading Component Score (if available)
Entered value should be number or empty string
Speakng Component Score (if available)
Entered value should be number or empty string
Listening Component Score (if available)
Entered value should be number or empty string
IELTS Test Report Form Number

Contact Information

Address *
(example: 12 Istiqbol Str., M.Ulugbek dist., Tashkent, Uzbekistan, 100047)
Home Phone Number (+998) *
Mobile Phone Number (+998) *
Email *
Confirm Email *

Passport Information – your application will be deleted if incorrect information is entered

Passport Series * / Passport Number *
Place Of Issue *
Given by IIB of (Kim Tomonidan Berilgan)
Date Of Issue *
Date Of Expiration *

Additional Information

Fee Status *

Confirmation

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