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Passport Application Form Government of INDIA, Ministry of External Affairs

Venkata Sujatha Ambati has submitted a passport application form providing personal details like name, date of birth, place of birth, address, contact information, and family details. She is applying for a fresh normal passport as an Indian citizen born in Macherla, Guntur Rural, Andhra Pradesh. She has included required documents like her Aadhaar card and has declared her allegiance to India.

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40 views2 pages

Passport Application Form Government of INDIA, Ministry of External Affairs

Venkata Sujatha Ambati has submitted a passport application form providing personal details like name, date of birth, place of birth, address, contact information, and family details. She is applying for a fresh normal passport as an Indian citizen born in Macherla, Guntur Rural, Andhra Pradesh. She has included required documents like her Aadhaar card and has declared her allegiance to India.

Uploaded by

Anonymous zxPwYlp2
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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29/09/2019 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 19-1009303255
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name VENKATA SUJATHA AMBATI
Date of Birth (DD/MM/YYYY) 08/06/1975
Validity Required NA
Place of Birth (Village/Town/City) MACHERLA
District GUNTUR RURAL
State/UT ANDHRA PRADESH
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? Y
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 828396472119
Family Details
Father's Name SRINIVASA RAO IMMADISETTY
Mother's Name THULASAMMA IMMADISETTY
Spouse's Name VENKATA KALADHAR AMBATI
Present Residential Address Details
Address FLAT NO-48,VISALANDHRA COLONY,PAYAKAPURAM, VIJAYAWADA, VIJAYAWADA CITY, ANDHRA PRADESH
PIN 520015
Police Station NUNNA
Mobile/Tel No. 7981277763
E-mail [email protected]
Permanent Residential Address
Address FLAT NO-48,VISALANDHRA COLONY,PAYAKAPURAM, VIJAYAWADA, VIJAYAWADA CITY, ANDHRA PRADESH
PIN 520015
Police Station NUNNA
Mobile/Tel No. 7981277763
Emergency Contact Details

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29/09/2019 Application Form
Name and Address AMBATI VENKATA ASISH,PLOT-48,VISALANDHRA COLONY,PAYAKAPURAM,VIJAYAWADA,520015
Mobile/Tel No. 9490351261
E-mail [email protected]
Other Details
Enclosures
1.Aadhaar Card/E-Aadhaar
2.Aadhaar Card/e-Aadhar containing the 12 digit Aadhaar number issued by the Unique Identification Authority of India(UIDAI)
Self Declaration
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 VIJAYAWADA
Date 29/09/2019

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