PPR Sample Form With Common Errors
PPR Sample Form With Common Errors
Signature/Left Hand
SABHARWAL
िदया गया नाम/Given Name(s)
AVINASH
राष्ट्रीयता/Nationality
} **FOR ANY CHANGE...
*EAIP
िलं ग/Sex
(AKA / ALIAS NOT ACCEPTED)
जन्मितिथ/Date of Birth
Thumb Impression in
INDIAN M 01/01/1990
the box provided below
जन्म स्थान/Place of Birth
SIGNATURE/THUMB
REQUIRED जारी करने की ितिथ/Date of Issue समािप्त की ितिथ/Date of Expiry
*EAIP
BRAMPTON ONTARIO
L6X1X4
पुराने पासपोटर् का नं. और इसके जारी होने की ितिथ एवं स्थान/Old Passport No with Date and Place of Issue
Service Required
Application Reference Number (ARN) 22-2004177782
Applying For REISSUE NOT FRESH
If Re-issue, specify reason(s)
VALIDITY EXPIRED WITHIN 3 YEARS/DUE TO EXPIRE.
Type of Application NORMAL / TATKAAL
PAY FEE ACCORDINGLY
* - FOR ANY CHANGE IN PERSONAL PARTICULARS, KINDLY REFER DETAILED CHECKLIST ON BLS WEBSITE
3) Provide the following details if the applicant has been refused/denied passport.
3.1) Have you ever been refused/denied passport? N
3.2) Has your passport ever been impounded? N
3.3) Has your passport ever been revoked? N
4) Provide the following details if applicant has applied for or been granted foreign citizenship.
4.1) Have you ever applied for or been granted citizenship by any other country? Y
Name of the countryCanada
PROVIDE SUPPORTING GOVERNMENT
4.2) Have you ever held the passport of any other country at any time?
ISSUED DOCUMENTS N
4.3) Have you ever surrendered your Indian passport?
IF ANY ANSWER IS YES N
4.4) Have you ever applied for renunciation of Indian citizenship? N
5) Provide the following details if applicant has returned to India on Emergency Certificate.
5.1) Have you ever returned to India on Emergency Certificate (EC)? N
5.2) Have you ever been deported from any country? N
5.3) Have you ever been repatriated from any country back to India? N
Self Declaration
I declare:
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.
I understand:
That Ministry of External Affairs (MEA) (or its implementation partner agencies/stakeholders/third parties) may undertake required checks to confirm the
accuracy and authenticity of evidence I have provided and documents I have submitted with this application.
That the information I provide, including biometric data (if any), will be treated in confidence, but it may be disclosed to other government departments, agencies,
local authorities, foreign governments, and other implementation partner agencies/stakeholders/third parties to enable MEA or those bodies to perform their
duties.
That providing biometric information, if collected as part of an application, is confirmation of my consent to getting the biometric information checked to verify
identity.
That the Passport and related services applications may be handled by the Indian Embassies/Consulates/ Passport Office/other offices including outside of the
country in which I have applied and that this may involve the transfer of my application and supporting documents to and from the respective offices.
That my details may, in certain circumstances, be passed to Police, Intelligence and other Fraud Detection & Prevention agencies. I also understand that such
agencies may provide related information about me to MEA.
- FOR ANY CHANGE IN PERSONAL PARTICULARS, KINDLY REFER DETAILED CHECKLIST ON BLS WEBSITE
*
• For change in Appearance OR Signatures, Self-Declaration on Plain Paper is required.