Application Form Flipbook PDF

Application Form

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27/06/2021

Application Form

PASSPORT APPLICATION FORM Government of INDIA, Ministry of External Affairs Service Required Application Reference Number Applying For Type of Application Type of Passport Booklet

21-0005187030 FRESH NORMAL NORMAL

Applicant Details Applicant's Name Date of Birth (DD/MM/YYYY) Validity Required Place of Birth (Village/Town/City) District State/UT Country Gender Marital Status Citizenship of India by Employment Type Is either of your parent (in case of minor)/spouse, a government servant? Educational Qualification Are you eligible for Non-ECR category? Aadhaar Number

PANKAJ KUMAR MISHRA 12/07/1990 NA VARANASI VARANASI UTTAR PRADESH INDIA MALE MARRIED BIRTH PRIVATE N 10TH PASS AND ABOVE Y 448979238404

Family Details Father's Name Mother's Name Spouse's Name

TILAK NARAYAN MISHRA JADAWATI DEVI RIMA MISHRA

Present Residential Address Details Address PIN Police Station Mobile/Tel No. E-mail

VILLAGE-EKADANGA, POST-DEIPUR, VARANASI, UTTAR PRADESH 221405 JANSA 9892493072 [email protected]

Permanent Residential Address Address PIN Police Station Mobile/Tel No.

VILLAGE-EKADANGA, POST-DEIPUR, VARANASI, UTTAR PRADESH 221405 JANSA 9892493072

Emergency Contact Details Name and Address Mobile/Tel No.

MANOJ PATHAK 9450314429

Other Details Enclosures 1.Aadhaar Card/E-Aadhaar 2.Aadhaar Card (Address Proof)

Self Declaration I owe allegiance to the sovereignty, unity & integrity of India, and have not voluntarily acquired citizenship or travel document of any other country. I have not lost, surrendered or been deprived of the citizenship of India. I have not contravened any of the conditions relating to the possession and use of an Indian passport. I affirm that the information and particulars given by me in this form are true and correct. I further state that I am not suppressing any material information in this regard. I further affirm that the enclosures and documentary proof submitted in support of my application for an Indian passport are authentic and solely pertain to me and I am fully responsible for the accuracy of the same. I am liable to be penalized or prosecuted if found otherwise. I am aware that under the Passports Act, 1967 it is a criminal offence to furnish any false information or to suppress any material information with a view to obtaining passport or travel document. I have read and understood the contents of the above and by submitting this form certify that all the information submitted by me in the form is bonafide. Place VARANASI https://portal1.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction

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27/06/2021

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Application Form

27/06/2021

https://portal1.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction

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