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Passport Application Form Government of INDIA, Ministry of External Affairs

This document contains an application form for an Indian passport. The applicant, Rajiv Kumar Maheshwari, is applying for a reissue of his passport due to expiration within 3 years. Personal details are provided such as name, date of birth, address, family details, employment, and previous passport information. At the end, the applicant signs a self-declaration affirming the accuracy of the information and acknowledging legal penalties for providing false details.

Uploaded by

Kanika Maheshwari
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
67 views

Passport Application Form Government of INDIA, Ministry of External Affairs

This document contains an application form for an Indian passport. The applicant, Rajiv Kumar Maheshwari, is applying for a reissue of his passport due to expiration within 3 years. Personal details are provided such as name, date of birth, address, family details, employment, and previous passport information. At the end, the applicant signs a self-declaration affirming the accuracy of the information and acknowledging legal penalties for providing false details.

Uploaded by

Kanika Maheshwari
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

7/22/13

Application Form

PASSPORTAPPLICATIONFORM
GovernmentofINDIA,MinistryofExternalAffairs
ServiceRequired
ApplicationReferenceNumber
ApplyingFor
IfReissue,specifyreason(s)
TypeofApplication
TypeofPassportBooklet
ApplicantDetails
Applicant'sName
DateofBirth(DD/MM/YYYY)
PlaceofBirth(Village/Town/City)
District
State/UT
Country
Gender
MaritalStatus
CitizenshipofIndiaby
VoterID
EmploymentType
Iseitherofyourparent(incaseofminor)/spouse,a
governmentservant?
EducationalQualification
AreyoueligibleforNonECRcategory?
AadhaarNumber
FamilyDetails
Father'sName
Mother'sName
Spouse'sName
PresentAddressDetails
ResidingSince(MM/YYYY)
Address
PIN
Mobile/TelNo
Email
FirstReferenceNameAndAddress
Mobile/TelNo
SecondReferenceNameAndAddress
Mobile/TelNo
PermanentAddress
Address
PIN
Mobile/TelNo
EmergencyContactDetails
NameandAddress

130008812762
REISSUE
VALIDITYEXPIREDWITHIN3YEARS/DUETOEXPIRE.
NORMAL
NORMAL
RAJIVKUMARMAHESHWARI
15/08/1964
ETAWA
ETAWAH
UTTARPRADESH
INDIA
MALE
MARRIED
BIRTH
HCN0882779
SELFEMPLOYED
N
10THPASSANDABOVE
Y
502936226143
RATANPRAKASHMAHESHWARI
SAVITAMAHESHWARI
SEEMAMAHESHWARI
10/1994
52/3B772CHURCHROADJAWALANAGARSHAHDARADELHI
EASTDELHIVIVEKVIHAR
110032
9811810777/01122380777
[email protected]
HIMANSHUSINGHAL3/108NEHRUGALIVISHWASNAGAR
SHAHDARADELHI110032
9999466669
ANKITSINGHAL3/108NEHRUGALIVISHWASNAGARSHAHDARA
DELHI110032
9999888388
52/3B772CHURCHROADJAWALANAGARSHAHDARADELHI
EASTDELHIVIVEKVIHAR
110032
9811810777/01122380777
DINESHSINGHAL3/108NEHRUGALIVISHWASNAGAR
SHAHDARADELHI110032
9212070666
9212070666

Mobile/TelNo
Mobile/TelNo
PreviousPassport/ApplicationDetails
Detailsoflatestheld/existing/lost/damagedOrdinaryPassport
PassportNumber
E3267726
DateofIssue
28/11/2002
DateofExpiry
27/11/2012
PlaceofIssue
DELHI
OtherDetails
SelfDeclaration
Ioweallegiancetothesovereignty,unityandintegrityofIndia,andhavenotvoluntarilyacquiredcitizenshiportravel
documentofanyothercountry.Ihavenotlost,surrenderedorbeendeprivedofthecitizenshipofIndiaandIaffirmthatthe
informationgivenbymeinthisformandtheenclosuresistrueandIamsolelyresponsibleforitsaccuracy,andIamliable
https://portal1.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction

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7/22/13

Application Form

tobepenalizedorprosecutediffoundotherwise.IamawarethatunderthePassportsAct,1967itisacriminaloffenceto
furnishanyfalseinformationortosuppressanymaterialinformationwithaviewtoobtainingpassportortraveldocument.
Place
DELHI
Date
22/07/2013

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

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