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SAMARTH SAMPAT GHORPADE has applied for an Indian passport as a fresh applicant. He has filled out the required application form providing personal details like name, date of birth, address, family details, educational qualifications, and payment details. He has also submitted the required documents and provided a self-declaration affirming that the information provided is true and he will abide by passport rules.

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55 views2 pages

Latest Application

SAMARTH SAMPAT GHORPADE has applied for an Indian passport as a fresh applicant. He has filled out the required application form providing personal details like name, date of birth, address, family details, educational qualifications, and payment details. He has also submitted the required documents and provided a self-declaration affirming that the information provided is true and he will abide by passport rules.

Uploaded by

Uprising Topics
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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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 22-0020894878
 
Applying For FRESH

Type of Application NORMAL

Type of Passport Booklet NORMAL


Applicant Details
Applicant's Name SAMARTH SAMPAT GHORPADE

Date of Birth (DD/MM/YYYY) 02/12/2001

Validity Required NA   

Place of Birth (Village/Town/City) MUMBAI

District MUMBAI

State/UT MAHARASHTRA

Region/Country INDIA
Signature/Left Hand Thumb Impression
Gender MALE of Illiterate Applicant and Minors who
Marital Status SINGLE cannot sign.
 
Citizenship of India by BIRTH  
 
PAN DLUPG9691B

Voter Id NNX4690905

Employment Type STUDENT

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 941062456948

Family Details
Father's Name SAMPAT NARAYAN GHORPADE

Mother's Name RAMESHWARI SAMPAT GHORPADE


Present Residential Address Details
B/703, ROSEWOOD, PRESTIGE RESIDENCY, WAGHBIL,
Address GHODBUNDER ROAD THANE WEST, THANE CITY,
MAHARASHTRA

PIN 400615

Police Station CHITALSAR MANPADA

Mobile/Tel No. 8850206903

E-mail [email protected]
Permanent Residential Address
J/8, JAIHIND COLONY, NANEPADA ROAD,, MULUND EAST,
Address
MUMBAI, MAHARASHTRA, INDIA

PIN 400081

Police Station MULUND

Mobile/Tel No. 8850206903


Emergency Contact Details
Name and Address SAMPAT GHORPADE THANE WEST

Mobile/Tel No. 9920184411


Other Details
Payment Details
Mode of Payment UPI

Date 06/12/2022

Receipt/Reference No. CPACGUUBF2

Amount Received (Rs.) 1500.00  (ONE THOUSAND FIVE HUNDRED ONLY)


Enclosures
1.PAN Card issued by the Income Tax Department

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 THANE Signature/Left Hand Thumb Impression of


Applicant (If applicant is minor, either parent
Date 18/02/2023 to sign)

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