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Application Form

Ajash Raja R P is applying for an Indian passport. He provides details such as his date of birth, place of birth, address, and enclosures including his birth certificate and Aadhaar card. He declares his allegiance to India and affirms that the information provided is true, knowing it is a criminal offense to provide false information to obtain a passport.

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AJAS RAJA
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49 views

Application Form

Ajash Raja R P is applying for an Indian passport. He provides details such as his date of birth, place of birth, address, and enclosures including his birth certificate and Aadhaar card. He declares his allegiance to India and affirms that the information provided is true, knowing it is a criminal offense to provide false information to obtain a passport.

Uploaded by

AJAS RAJA
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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8/7/2019 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 19-1007609125
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name AJAS RAJA R P
Date of Birth (DD/MM/YYYY) 17/12/1996
Validity Required NA
Place of Birth (Village/Town/City) VAGAVURRAI ESTATE
District IDUKKI
State/UT KERALA
Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
Employment Type NOT EMPLOYED
Is either of your parent (in case of minor)/spouse, a
Y
government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 597841191819
Family Details
Father's Name M RAJAGOPAL
Mother's Name A PADMINI
Present Residential Address Details
KANNIMALAI LOWER, NAYAMAKKAD ESTATE, MUNNAR, KANNAN DEVAN
Address
HILLS, MUNNAR, IDUKKI, KERALA
PIN 685612
Police Station MUNNAR
Mobile/Tel No. 9495421224
E-mail [email protected]
Permanent Residential Address
KANNIMALAI LOWER, NAYAMAKKAD ESTATE, MUNNAR, KANNAN DEVAN
Address
HILLS, MUNNAR, IDUKKI, KERALA
PIN 685612
Police Station MUNNAR
Mobile/Tel No. 9495421224
Emergency Contact Details
Name and Address A PADMINI (H M), ALPS KALAAR, MUNNAR P.O
Mobile/Tel No. 9495990342
Other Details
Enclosures
1.Birth Certificate issued by the Registrar of Births and Deaths or the Municipal Corporation or any other prescribed authority,whosoever
has been empowered under the Registration of Birth and Deaths Act, 1969 to register the birth of a child born in India
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 MUNNAR

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8/7/2019 Application Form
Date 07/08/2019

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