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Ravinder has submitted an application for a fresh normal Indian passport. He has provided all required personal details like name, date of birth, place of birth, address, family details, and contact information. He has also submitted his Aadhaar card and Aadhaar address proof as required documents. In the self-declaration, he has affirmed his allegiance to India and that he is not holding any other citizenship. He has also certified that all information provided is true.

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OUTSTANDING DEAL
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52 views

View - Print Submitted Form

Ravinder has submitted an application for a fresh normal Indian passport. He has provided all required personal details like name, date of birth, place of birth, address, family details, and contact information. He has also submitted his Aadhaar card and Aadhaar address proof as required documents. In the self-declaration, he has affirmed his allegiance to India and that he is not holding any other citizenship. He has also certified that all information provided is true.

Uploaded by

OUTSTANDING DEAL
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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File Number (For Office Use Only)

GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS

PASSPORT APPLICATION FORM

Please read the Passport Instruction Booklet carefully before filling 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
application and would attract penal provisions as prescribed under the Passports Act, 1967. Please produce your original
documents at the time of submission of the form.

Service Required  
 
Application Reference Number 21-0009198420
 
Applying For FRESH

Type of Application NORMAL

Type of Passport Booklet NORMAL


Applicant Details
Applicant's Name RAVINDER

Alias Name1 RAVINDER YADAV

Date of Birth (DD/MM/YYYY) 31/10/1998   

Validity Required NA

Place of Birth (Village/Town/City) NANGAL SIROHI

District MAHENDRAGARH

State/UT HARYANA
Signature/Left Hand Thumb Impression
Region/Country INDIA of Illiterate Applicant and Minors
who
Gender MALE cannot sign.
 
Marital Status MARRIED  
 
Citizenship of India by BIRTH

Employment Type PRIVATE

Is either of your parent (in case of


N
minor)/spouse, a government servant?

Educational Qualification GRADUATE AND ABOVE

Are you eligible for Non-ECR category? Y

Aadhaar Number 894462206089

Family Details
Father's Name PAPPU YADAV

Mother's Name BALKESH DEVI

Spouse's Name KOMAL YADAV


Present Residential Address Details
KHAROLI ROAD BHUKDA MOHALLA NANGAL SIROHI (104),
Address
NANGAL SIROHI, MAHENDRAGARH, HARYANA

PIN 123028

Police Station MAHENDERGARH

Mobile/Tel No. 8800517155


E-mail [email protected]
Permanent Residential Address
KHAROLI ROAD BHUKDA MOHALLA NANGAL SIROHI (104),
Address
NANGAL SIROHI, MAHENDRAGARH, HARYANA

PIN 123028

Police Station MAHENDERGARH

Mobile/Tel No. 8800517155


Emergency Contact Details
RAVINDER KHAROLI ROAD MOHALLA BHUKDA NANGAL
Name and Address
SIROHI 104 MAHENDRAGARH HARYANA 123028

Mobile/Tel No. 8800517155

E-mail [email protected]
Other Details
Fee Details (Not to be filled by applicants submitting the application at Passport Seva Kendra/Passport Office)
Fee amount in (Rs)  

If paid by Demand Draft(DD), provide the following details

DD Issue Date (dd/mm/yyyy)  

DD Expiry Date (dd/mm/yyyy)  

Bank Name  

Branch  
Enclosures
1.Aadhaar Card/E-Aadhaar

2.Aadhaar Card (Address Proof)


Self Declaration

I owe allegiance to the sovereignty, unity & 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. I have not contravened any of the conditions
relating to the possession and use of an Indian passport.
I affirm that the information and particulars given by me in this form are true and correct. I further state that I am not suppressing
any material information in this regard. I further affirm that the enclosures and documentary proof submitted in support of my
application for an Indian passport are authentic and solely pertain to me and I am fully responsible for the accuracy of the same. 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.
I 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 GURGAON Signature/Left Hand Thumb Impression of


Applicant
(If applicant is minor, either parent
Date 03/10/2021 to sign)

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