Service Required Application Reference Number 23-1013360255 Applying For FRESH Type of Application NORMAL Type of Passport Booklet NORMAL Applicant Details Applicant's Name FAHIMA Date of Birth (DD/MM/YYYY) 01/01/1973 Validity Required NA Place of Birth (Village/Town/City) BENGALURU District BENGALURU State/UT KARNATAKA Region/Country INDIA Gender FEMALE Marital Status MARRIED Citizenship of India by BIRTH PAN AIDPF6816G Voter Id DFK1550516 Employment Type HOME MAKER Is either of your parent (in case of minor)/spouse, a N government servant? Educational Qualification 7TH PASS OR LESS Are you eligible for Non-ECR category? Y Aadhaar Number 485321248321 Family Details Father's Name ABDUL LATIF Spouse's Name ABUBAKAR SIDDIQ Present Residential Address Details 187,SHARIFF NAGAR HUTS,YESHWANTHPURA, BENGALURU, Address BENGALURU, KARNATAKA PIN 560022 Police Station YESHWANTHAPURA Mobile/Tel No. 9743244785 E-mail MMDAYUB@GMAIL.COM Permanent Residential Address 187,SHARIFF NAGAR HUTS,YESHWANTHPURA, BENGALURU, Address BENGALURU, KARNATAKA PIN 560022 Police Station YESHWANTHAPURA Mobile/Tel No. 9743244785 Emergency Contact Details Name and Address MOHAMMED AYUB Mobile/Tel No. 9845397825 E-mail MMDAYUB@GMAIL.COM 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.
https://portal2.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 1/2 10/30/23, 7:06 PM Application Form 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 BANGALORE Date 30/10/2023
