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Passport Application Form Government of INDIA, Ministry of External Affairs

Anish Rethanam Mony is applying for a fresh normal passport. He provides details such as his date of birth, place of birth, address, father's name, employment status, and contact information for references. He declares his allegiance to India and affirms that all information provided is true.

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GiriTamilnadu
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Download as PDF, TXT or read online on Scribd
36 views

Passport Application Form Government of INDIA, Ministry of External Affairs

Anish Rethanam Mony is applying for a fresh normal passport. He provides details such as his date of birth, place of birth, address, father's name, employment status, and contact information for references. He declares his allegiance to India and affirms that all information provided is true.

Uploaded by

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

9/23/2015

ApplicationForm

PASSPORTAPPLICATIONFORM
GovernmentofINDIA,MinistryofExternalAffairs
ServiceRequired
ApplicationReferenceNumber
ApplyingFor
TypeofApplication
TypeofPassportBooklet

151008600209
FRESH
NORMAL
NORMAL

ApplicantDetails
Applicant'sName
ANISHRETHENAMONY
DateofBirth(DD/MM/YYYY)
04/09/1991
ValidityRequired
NA
PlaceofBirth(Village/Town/City)
EZHUDESAM
District
KANYAKUMARI
State/UT
TAMILNADU
Country
INDIA
Gender
MALE
MaritalStatus
SINGLE
CitizenshipofIndiaby
BIRTH
VoterId
XAD1222942
EmploymentType
NOTEMPLOYED
Iseitherofyourparent(incaseofminor)/spouse,a
N
governmentservant?
EducationalQualification
GRADUATEANDABOVE
AreyoueligibleforNonECRcategory?
N
VisibleDistinguishingMark
ABLACKMOLEONRIGHTCHEEKS
AadhaarNumber
525420141111

FamilyDetails
Father'sName

RETHENAMONY

PresentResidentialAddressDetails
ResidingSince(MM/YYYY)
Address
PIN
Mobile/TelNo.
Email
FirstReferenceNameAndAddress
Mobile/TelNo.
SecondReferenceNameAndAddress
Mobile/TelNo.

09/1991
18/8NEDUVILAI,ARASAKULAM,,THENGAPATTANAM,PUTHUKADAI,
KANYAKUMARI,TAMILNADU
629173
9597707110
[email protected]
ASWANTHTHENGAPATTANAM
9629053234
DEPAGIRITHENGAPATTANAM
9790474822

PermanentResidentialAddress
Address
PIN
Mobile/TelNo.

18/8NEDUVILAI,ARASAKULAM,,THENGAPATTANAM,PUTHUKADAI,
KANYAKUMARI,TAMILNADU
629173
9597707110

EmergencyContactDetails
NameandAddress
Mobile/TelNo.
Mobile/TelNo.

JOBIN,PIRAVIVILAI,PUTHUKADAI.
9791927253
9791927253

OtherDetails
SelfDeclaration
Ioweallegiancetothesovereignty,unityandintegrityofIndia,andhavenotvoluntarilyacquiredcitizenshiportravel
documentofanyothercountry.Ihavenotlost,surrenderedorbeendeprivedofthecitizenshipofIndiaandIaffirmthatthe
informationgivenbymeinthisformandtheenclosuresistrueandIamsolelyresponsibleforitsaccuracy,andIamliable
tobepenalizedorprosecutediffoundotherwise.IamawarethatunderthePassportsAct,1967itisacriminaloffenceto
furnishanyfalseinformationortosuppressanymaterialinformationwithaviewtoobtainingpassportortraveldocument.
Place
ARASAKULAM
https://portal2.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction

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9/23/2015

Date

ApplicationForm

23/09/2015

https://portal2.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction

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