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Passport Application Form Government of INDIA, Ministry of External Affairs

Mubeen Taj, a 54-year old homemaker from Mandya, Karnataka, India has applied for a new normal passport. She provides her personal details including name, date of birth, place of birth, gender, marital status, parents' names, spouse's name, present and permanent addresses, contact information, references, and self-declaration affirming her Indian citizenship and that the information provided is accurate.

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shaik41
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53 views

Passport Application Form Government of INDIA, Ministry of External Affairs

Mubeen Taj, a 54-year old homemaker from Mandya, Karnataka, India has applied for a new normal passport. She provides her personal details including name, date of birth, place of birth, gender, marital status, parents' names, spouse's name, present and permanent addresses, contact information, references, and self-declaration affirming her Indian citizenship and that the information provided is accurate.

Uploaded by

shaik41
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs


Service Required
Application Reference Number 14-1004663755
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Validity Required NA
Applicant Details
Applicant's Name MUBEEN TAJ
Date of Birth (DD/MM/YYYY) 08/06/1969
Place of Birth (Village/Town/City) CHANNAPATNA
District RAMANAGAR
State/UT KARNATAKA
Country INDIA
Gender FEMALE
Marital Status MARRIED
Citizenship of India by BIRTH
Employment Type HOME MAKER
Is either of your parent (in case of
minor)/spouse, a government servant?
N
Educational Qualification 5TH PASS OR LESS
Are you eligible for Non-ECR category? N
Family Details
Father's Name SHAIK SULAIMAN BASHA
Mother's Name HAJIYA LALA BI
Spouse's Name AZEEZ KHAN
Present Address Details
Residing Since(MM/YYYY) 06/2010
Address
NO 99 2ND CROSS SADATHNAGAR GUTHAL ROAD, MANDYA, EAST
POLICE STATION MANDYA, MANDYA, KARNATAKA
PIN 571403
Mobile/Tel No. 8050241321
E-mail [email protected]
First Reference Name And Address
PYARE JAN SADATHNAGAR 14 MAIN 2ND CROSS GULTHAL ROAD
MANDYA
Second Reference Name And Address
MAHBOOB KHAN SADATHNAGAR 1ST MAIN 1ST CROSS GUTHAL ROAD
MANDYA
Permanent Address
Address
NO 99 2ND CROSS SADATHNAGAR GUTHAL ROAD, MANDYA, EAST
POLICE STATION MANDYA, MANDYA, KARNATAKA
PIN 571403
Mobile/Tel No. 8050241321
Emergency Contact Details
Name and Address AFZAL
Mobile/Tel No. 8050241321
Mobile/Tel No. 8050241321
Other Details
Self Declaration
Application Form https://portal2.passportindia.gov.in/AppOnlineProject/secure...
1 of 2 03/06/14 7:53 PM
I owe allegiance to the sovereignty, unity and 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 and I affirm that
the information given by me in this form and the enclosures is true and I am solely responsible for its accuracy, and 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.
Place BANGALORE
Date 03/06/2014
Application Form https://portal2.passportindia.gov.in/AppOnlineProject/secure...
2 of 2 03/06/14 7:53 PM

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