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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 23-1012480545

Applying For FRESH

Type of Application NORMAL

Type of Passport Booklet NORMAL

Applicant Details
Applicant's Name SWETHA KAMAJI

Date of Birth (DD/MM/YYYY) 07/04/2000

Validity Required NA

Place of Birth (Village/Town/City) HYDERABAD

District HYDERABAD

State/UT TELANGANA

Region/Country INDIA
Signature/Left Hand Thumb Impression
Gender FEMALE
of Illiterate Applicant and Minors who
Marital Status SINGLE cannot sign.

Citizenship of India by BIRTH

PAN NOCPS9424H

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

Visible Distinguishing Mark A MOLE ON THE RIGHT CHEEK

Aadhaar Number 930916069952

Family Details
Father's Name SATHAIAH KAMAJI

Mother's Name JANGAMMA KAMAJI

Present Residential Address Details
17-2-626/9 MADANNAPET, SAIDABAD, HYDERABAD,
Address
TELANGANA

PIN 500059

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Police Station MADANNAPET

Mobile/Tel No. 6281722326

E-mail [email protected]
Permanent Residential Address
17-2-626/9 MADANNAPET, SAIDABAD, HYDERABAD,
Address
TELANGANA

PIN 500059

Police Station MADANNAPET

Mobile/Tel No. 6281722326

Emergency Contact Details
Name and Address KAMAJI SATHAIAH

Mobile/Tel No. 8008447025

Other Details
Payment Details
Mode of Payment Online/Internet Banking

Date 07/10/2023

Receipt/Reference No. CHN8837081

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

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 HYDERABAD Signature/Left Hand Thumb Impression of

Applicant (If applicant is minor, either parent
Date 07/10/2023 to sign)

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