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Application Form (Umadevi)

The document is an application form for an Indian passport. It contains personal details of the applicant such as name, date of birth, address, family details. It also contains a self declaration where the applicant affirms the details provided are true.

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Gumma's Digital communications 'e' Seva
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147 views2 pages

Application Form (Umadevi)

The document is an application form for an Indian passport. It contains personal details of the applicant such as name, date of birth, address, family details. It also contains a self declaration where the applicant affirms the details provided are true.

Uploaded by

Gumma's Digital communications 'e' Seva
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Application Form https://portal2.passportindia.gov.in/AppOnlineProject/secure/Applican...

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-1004247877
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name UMADEVI GUMMA
Date of Birth (DD/MM/YYYY) 09/06/1988
Validity Required NA
Place of Birth (Village/Town/City) VELLAM PALLE
District PRAKASAM
State/UT ANDHRA PRADESH
Region/Country INDIA
Gender FEMALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN CBDPG0872J
Employment Type HOME MAKER
Is either of your parent (in case of minor)/
N
spouse, a government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 724564828742
Family Details
Father's Name SRINU MALLEBOINA
Mother's Name VENKATA RAMANA MALLEBOINA
Spouse's Name HANUMANTHA RAO GUMMA
Present Residential Address Details
0-0 KALYANI HOTEL,OPPOSITE TOBOCO BOARD, VELLAM PALLE, PRAKASAM,
Address
ANDHRA PRADESH
PIN 523211
Police Station MADDIPADU
Mobile/Tel No. 7729055556
E-mail [email protected]
Permanent Residential Address
0-0 KALYANI HOTEL,OPPOSITE TOBOCO BOARD, VELLAM PALLE, PRAKASAM,
Address
ANDHRA PRADESH
PIN 523211
Police Station MADDIPADU
Mobile/Tel No. 7729055556
Emergency Contact Details
C/O GUMMA HANUMANTHA RAO,GUMMA HANUMANTHA RAO 0-0, KALYANI HOTAL
Name and Address
OPPOSITE TOBOCCO BOARD VELLAM PALLE
Mobile/Tel No. 7207955556
Other Details
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 ONGOLE

1 of 2 3/31/2024, 6:56 PM
Application Form https://portal2.passportindia.gov.in/AppOnlineProject/secure/Applican...

Date 31/03/2024

2 of 2 3/31/2024, 6:56 PM

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