Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 24 views

    PASSPORT - Print Submitted Form

    Uploaded by

    DEVENDRA YADAV
    The document is a passport application form filled out by Devendra from Uttar Pradesh, India. It contains his personal details like name, date of birth, address, as well as documents submitted for the application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    PASSPORT - Print Submitted Form

    Uploaded by

    DEVENDRA YADAV
    24 views2 pages
    The document is a passport application form filled out by Devendra from Uttar Pradesh, India. It contains his personal details like name, date of birth, address, as well as documents submitted for the application.

    Original Title

    PASSPORT_Print Submitted Form

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document is a passport application form filled out by Devendra from Uttar Pradesh, India. It contains his personal details like name, date of birth, address, as well as documents submitted for the application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    24 views2 pages

    PASSPORT - Print Submitted Form

    Uploaded by

    DEVENDRA YADAV
    The document is a passport application form filled out by Devendra from Uttar Pradesh, India. It contains his personal details like name, date of birth, address, as well as documents submitted for the application.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    3/17/24, 5:48 PM View/Print Submitted Form

    File Number (For Office Use Only)

    GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS

    PASSPORT APPLICATION FORM

    Please read the Passport Instruction Booklet carefully before filling the form. Fill this form in CAPITAL LETTERS using
    blue/black ink ball point pen only. Furnishing of incorrect information/ suppression of information would lead to rejection of the
    application and would attract penal provisions as prescribed under the Passports Act, 1967. Please produce your original
    documents at the time of submission of the form.

    Service Required
    Application Reference Number 24-0004404430

    Applying For FRESH

    Type of Application NORMAL

    Type of Passport Booklet NORMAL


    Applicant Details
    Applicant's Name DEVENDRA

    Date of Birth (DD/MM/YYYY) 20/07/1999

    Validity Required NA

    Place of Birth (Village/Town/City) VILLAGE TARAINI

    District SANT KABIR NAGAR

    State/UT UTTAR PRADESH

    Region/Country INDIA
    Signature/Left Hand Thumb Impression
    Gender MALE of Illiterate Applicant and Minors who
    Marital Status SINGLE cannot sign.

    Citizenship of India by BIRTH

    PAN GVUPD9027D

    Employment Type OTHERS

    Is either of your parent (in case of


    N
    minor)/spouse, a government servant?

    Educational Qualification 10TH PASS AND ABOVE

    Are you eligible for Non-ECR category? Y

    Visible Distinguishing Mark CUT MARK RIGHT SIDE KNEE

    Aadhaar Number 921783219581

    Family Details
    Father's Name JHINKAN

    Mother's Name SONMATI DEVI

    Legal Guardian's Name JHINKAN


    Present Residential Address Details
    VILLAGE AND POST TARAINI TEHSIL KHALILABAD, TARAINI,
    Address
    SANT KABIR NAGAR, UTTAR PRADESH

    https://portal1.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=24-0004404430 1/2
    3/17/24, 5:48 PM View/Print Submitted Form

    PIN 272164

    Police Station MAHULI

    Mobile/Tel No. 7408548435

    E-mail DY997646@GMAIL.COM
    Permanent Residential Address
    VILLAGE AND POST TARAINI TEHSIL KHALILABAD, TARAINI,
    Address
    SANT KABIR NAGAR, UTTAR PRADESH

    PIN 272164

    Police Station MAHULI

    Mobile/Tel No. 7408548435


    Emergency Contact Details
    JHINKAN YADAV VILLAGE AND POST TARAINI TEHSIL
    Name and Address KHALILABAD DISTRICT SANT KABIR NAGAR STATE UTTAR
    PRADESH

    Mobile/Tel No. 8423600609


    Other Details
    Payment Details
    Mode of Payment Online/Internet Banking

    Date 15/03/2024

    Receipt/Reference No. IGAQZPTBD6

    Amount Received (Rs.) 1500.00 (ONE THOUSAND FIVE HUNDRED ONLY)


    Enclosures
    1.Transfer/School leaving/Matriculation Certificate issued by the school last attended/recognized educational board

    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 KHALILABAD Signature/Left Hand Thumb Impression of


    Applicant (If applicant is minor, either parent
    Date 15/03/2024 to sign)

    https://portal1.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=24-0004404430 2/2

    You might also like