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    Passport Application Form Government of INDIA, Ministry of External Affairs

    Uploaded by

    Swapneel Prasanth Mishra
    The document is a passport application form for Swapneel Prasanth Mishra from India. It includes personal details like name, date of birth, address, contact information, as well as family details. It specifies that Swapneel is applying for a reissue of his passport due to its expiration within 3 years and lists details of his previous passport like the passport number and place of issue. The form is dated June 8, 2016 and includes a self-declaration by Swapneel that the information provided is true.

    Copyright:

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

    Passport Application Form Government of INDIA, Ministry of External Affairs

    Uploaded by

    Swapneel Prasanth Mishra
    22 views2 pages
    The document is a passport application form for Swapneel Prasanth Mishra from India. It includes personal details like name, date of birth, address, contact information, as well as family details. It specifies that Swapneel is applying for a reissue of his passport due to its expiration within 3 years and lists details of his previous passport like the passport number and place of issue. The form is dated June 8, 2016 and includes a self-declaration by Swapneel that the information provided is true.

    Original Description:

    passport

    Original Title

    Application Form

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    © © All Rights Reserved

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    The document is a passport application form for Swapneel Prasanth Mishra from India. It includes personal details like name, date of birth, address, contact information, as well as family details. It specifies that Swapneel is applying for a reissue of his passport due to its expiration within 3 years and lists details of his previous passport like the passport number and place of issue. The form is dated June 8, 2016 and includes a self-declaration by Swapneel that the information provided is true.

    Copyright:

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

    Passport Application Form Government of INDIA, Ministry of External Affairs

    Uploaded by

    Swapneel Prasanth Mishra
    The document is a passport application form for Swapneel Prasanth Mishra from India. It includes personal details like name, date of birth, address, contact information, as well as family details. It specifies that Swapneel is applying for a reissue of his passport due to its expiration within 3 years and lists details of his previous passport like the passport number and place of issue. The form is dated June 8, 2016 and includes a self-declaration by Swapneel that the information provided is true.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    6/8/2016

    ApplicationForm

    PASSPORTAPPLICATIONFORM
    GovernmentofINDIA,MinistryofExternalAffairs
    ServiceRequired
    ApplicationReferenceNumber
    ApplyingFor
    IfReissue,specifyreason(s)
    TypeofApplication
    TypeofPassportBooklet

    161005045139
    REISSUE
    VALIDITYEXPIREDWITHIN3YEARS/DUETOEXPIRE.
    NORMAL
    JUMBO

    ApplicantDetails
    Applicant'sName
    DateofBirth(DD/MM/YYYY)
    ValidityRequired
    PlaceofBirth(Village/Town/City)
    District
    State/UT
    Country
    Gender
    MaritalStatus
    CitizenshipofIndiaby
    PAN
    EmploymentType
    Iseitherofyourparent(incaseof
    minor)/spouse,agovernmentservant?
    EducationalQualification
    AreyoueligibleforNonECRcategory?
    VisibleDistinguishingMark
    AadhaarNumber

    SWAPNEELPRASANTHMISHRA
    26/04/1985
    NA
    BAGDEHI
    JHARSUGUDA
    ODISHA
    INDIA
    MALE
    MARRIED
    BIRTH
    AQCPM4525E
    PRIVATE
    N
    GRADUATEANDABOVE
    Y
    SCARONRIGHTHAND
    990697727958

    FamilyDetails
    Father'sName
    Mother'sName
    Spouse'sName

    MOHANKUMARMISHRA
    JAYASHREEMISHRA
    DEEPIKADASH

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

    12/2014
    1482NDFLOOR1STMAIN3RDCROSSMALLAPPALAYOUT,BANGALORE,
    HENNUR,BENGALURU,KARNATAKA
    560043
    9740700994/09740700994
    [email protected]
    PARIKANNAPPANNO14THCROSS3RDBLOCK,DASAPPA
    LAYOUT,RAMMURTHYNAGAR560016
    9986432541
    TAPANSAMALNO27GRNDFLOORASHIRWADCOLONYP&TLAYOUT
    HORAMAVU,LANDMARKDEVAMATHACENTRALSCHOOL
    9036122894

    PermanentResidentialAddress
    Address
    PIN
    Mobile/TelNo.

    HIG4SDACOLONY,SAMBALPUR,BURLA,SAMBALPUR,ODISHA,INDIA
    768017
    09437125001/09437125001

    EmergencyContactDetails
    NameandAddress
    Mobile/TelNo.
    Email

    MOHANKUMARMISHRA,E4/34AREA7&8CIVILTOWNSHIPROURKELA
    769004
    9437125001/06612664984
    [email protected]

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

    1/2

    6/8/2016

    ApplicationForm

    PreviousPassport/ApplicationDetails
    Detailsoflatestheld/existing/lost/damagedOrdinaryPassport
    PassportNumber
    DateofIssue
    DateofExpiry
    PlaceofIssue
    FileNumber

    G0596212
    13/12/2006
    12/12/2016
    BHUBANESWAR
    BHUA02162806

    OtherDetails
    SelfDeclaration
    Ioweallegiancetothesovereignty,unityandintegrityofIndia,andhavenotvoluntarilyacquiredcitizenshiportraveldocument
    ofanyothercountry.Ihavenotlost,surrenderedorbeendeprivedofthecitizenshipofIndiaandIaffirmthattheinformation
    givenbymeinthisformandtheenclosuresistrueandIamsolelyresponsibleforitsaccuracy,andIamliabletobepenalized
    orprosecutediffoundotherwise.IamawarethatunderthePassportsAct,1967itisacriminaloffencetofurnishanyfalse
    informationortosuppressanymaterialinformationwithaviewtoobtainingpassportortraveldocument.
    Place
    BANGALORE
    Date
    08/06/2016

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

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