112873, 051 AM View/Print 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. Fil 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 prescrived 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 (ODIMMIYYYY) Validity Required Place of Birth (Village/Town/City) District State/UT Rogion/Country Gender Marital Status Citizenship of India by PAN Voter id Employment Type Is either of your parent (in case of minor)/spouse, a government servant? Educational Qualification ‘Are you eligible for Non-ECR category? ‘Aadhaar Number Father's Name Mother's Name ‘Spouse's Name hitpssportalt passportneia. govin/AppOnlineProjactsecureViewDrattAction ar 22-0019431514 FRESH NORMAL NORMAL Please paste your Lursignedl recent color photogroph cf ize NARENDER SINGH BHASIN 48an * 9.6m 307087 NA AMRITSAR AMRITSAR PUNJAB INDIA ‘Signature/Left Hand Thumb Impression of literate Applicant and Minors who MARRIED cannot sign MALE, BIRTH AFIPS7856M |AAB1476126 SELF EMPLOYED N GRADUATE AND ABOVE Y 783673146035, KULBIR SINGH BHASIN UTTAM KAUR KARAMJEET KAUR BHASIN 2.0019431514 1112873, 051 AM Address PIN Police Station MobileTel No. E-mail Address PIN Police Station Mobile/Tel No. Name and Address Mobile/Tel No, Mode of Payment Date RecelptiReference No, ‘Amount Received (Rs.) View/Print Submited Form 284, URBAN ESTATE PHASE 2 DUGRI,, LUDHIANA, LUDHIANA, PUNJAB +4102 DusRI 9815160908 [email protected] 284, URBAN ESTATE PHASE 2 DUGRI,, LUDHIANA, LUDHIANA, PUNJAB 141002 DUGRI 9815160906 HARJAS KAUR BHASIN 9888071838 Debitiredit Card sarsi2022 (CPACFDHANT 1350.00 (ONE THOUSAND THREE HUNDRED AND FIFTY ONLY) 4.Election Photo Identity Card (EPIC) issued by the Election Commission of India 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 other country. I have not lost, surrendered or been deprived ofthe 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 not suppressing ‘any material information in this regard. | 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 | am fully responsible for the accuracy of the same. | ‘am liable to be penalized or prosecuted i found otherwise. | am aware that under the Passports Act, 1967 itis a criminal offence to furnish any false information or to suppress any material information with a view to oblaining 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 bonatie. Place LUDHIANA Date sa/t112022 hitpssportalt passportneia. govin/AppOnlineProjactsecureViewDrattaction ar ‘Signature/Left Hand Thumb Impression of Applicant (If applicant is minor, either parent 20112873, 051 AM View/Print Submited Form hitpssportalt passportneia. govin/AppOnlineProjactsecure!ViewDrattAction ar a