211122, 3:58 PM ViewiPrint Submited Form File Number (For Office Use Only) GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS PASSPORT APPLICATION FORM Please read the Passport Instruction Booklet carefully before filing the form. Fill this form in CAPITAL LETTERS using blue/black ink ball point pen only. Furnishing of incorrect information’ suppression of information would lead to rejection of the ‘pplication and would attract penal provisions as prescribed under the Passports Act, 1967. Please produce your original documents at the time of submission ofthe form, ‘Application Reference Number Applying For Type of Application ‘Type of Passport Booklet Applicant's Name Date of Birth (OD/MMIYYYY) Validity Required Place of Birth (Village/Town/City) District StatelUT Rogion/Country Gender Marital Status Citizenship of India by PAN Employment Type 's either of your parent (in case of minor)/spouse, a government servant? Educational Qualification ‘Are you eligible for Non-ECR category? Visible Distinguishing Mark ‘Aadhaar Number Father's Name Mother's Name htpssportalt passportnela. gov in/AppOnlineProjectisecuralViewDrattAction?ar: 22-0001961036 FRESH NORMAL NORMAL AYUSH oaioeit992 NA MUZAFFARNAGAR MUZAFFARNAGAR UTTAR PRADESH INDIA MALE SINGLE BIRTH CTNPK2B506 PRIVATE N GRADUATE AND ABOVE Y CUT ON FOREHEAD 342736198859 VINAY KUMAR, SUNITA Please page your uncignes recent color photogroph of 325 45cm * Som. ‘Signature/Left Hand Thumb Impression of literate Applicant and Minors who ‘cannot sign.211122, 3:58 PM Address PIN Police Station Mobile/Tel No, E-mail Address PIN Police Station Mobile/Tel No, Name and Address Mobile/Tel No, Mode of Payment Date RecelptiReference: ‘Amount Received ( No. Rs.) 1.Aadhaar CardlE-Aadhaar 2.Aadhaar Card (Address Proof) | owe allegiance to the sovereignty, unity & integrity of India, and have not voluntarily acquired citizenship or travel document of any ‘ther country | have not lost, surrendered or been deprived of the citizenship of India, | have not contravened any of the conditions relating to the possession and use of an Indian passport | affirm that the information and particulars given by me in this form are true and correct. | further state that | am nat suppressing ‘any material information in this regard. | further affirm that the enclosures and documentary proof submitted in support of my pplication for an Indian passport are authentic and solely pertain to me end Iam fully responsible for the accuracy of the same. | ‘am liable to be penalized or prosecuted if found otherwise, | am aware that under the Passports Act, 1967 itis @ criminal offence to ViewiPrint Submited Form 1862 GALI NO 4 CIVIL LINE, DAKSHINI, MUZAFFARNAGAR, UTTAR PRADESH 251001 Heese 9560374177 [email protected] 1862 GALI NO 4 CIVIL LINE, DAKSHINI, MUZAFFARNAGAR, UTTAR PRADESH 251001 Hee+Be 9560374177 VINAY KUMAR, 19411450005 Debiticredit Card wozr2022 cpaskecitt 1500.00 (ONE THOUSAND FIVE HUNDRED ONLY) furnish any false information or to suppress any material information with a view to obtaining passport or travel document. | have read and understood the contents of the above and by submitting this form certify that all the information submitted by me in the form is bonafide. Place MUZAFFARNAGAR Date htpssportalt passportnela. gov in/AppOnlineProjectisecuralViewDrattAction?ar: sw1ozi2022 SignatureiLeft Hand Thumb Impression of Applicant (If applicant is minor, either parent to sign) 22.