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Application Form

The document is a passport application form containing personal details such as name, date of birth, address, parents' names, employment, and passport details. The form requests information to process an application for a reissue of passport due to expiry within 3 years. It contains sections for applicant details, family details, present and permanent addresses, emergency contact, and previous passport details.

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akshay.napte2014
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95 views2 pages

Application Form

The document is a passport application form containing personal details such as name, date of birth, address, parents' names, employment, and passport details. The form requests information to process an application for a reissue of passport due to expiry within 3 years. It contains sections for applicant details, family details, present and permanent addresses, emergency contact, and previous passport details.

Uploaded by

akshay.napte2014
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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PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-0008268150
Applying For REISSUE
If Re-issue, specify reason(s) VALIDITY EXPIRED WITHIN 3 YEARS/DUE TO EXPIRE.
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name SHAILESH KUMAR RATNESH KUMAR SINGH
Date of Birth (DD/MM/YYYY) 20/01/1987
Validity Required NA
Place of Birth (Village/Town/City) HARIPUR
District VAISHALI
State/UT BIHAR
Region/Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN BTTPS6547K
Employment Type PRIVATE
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? N
Aadhaar Number 707832414621
Family Details
Father's Name RATNESH KUMAR SHRIKAILASH SINGH
Mother's Name MANJU RATNESH SINGH
Spouse's Name AISHWARYA SHAILESH KUMAR SINGH
Present Residential Address Details
FLAT NO A-403 GAT NO 41 ORBIT BOONEVILLE, SHIVAJIWADI MOSHI, PIMPRI
Address
CHINCHWAD, MAHARASHTRA
PIN 412105
Police Station BHOSARI MIDC
Mobile/Tel No. 9762749347
E-mail [email protected]
Permanent Residential Address
FLAT NO A-403 GAT NO 41 ORBIT BOONEVILLE, SHIVAJIWADI MOSHI, PIMPRI
Address
CHINCHWAD, MAHARASHTRA
PIN 412105
Police Station BHOSARI MIDC
Mobile/Tel No. 9762749347
Emergency Contact Details
AISHWARYA SHAILESH KUMAR SINGH FLAT NO A-403 GAT NO 41 ORBIT
Name and Address
BOONVILLE SHIVAJIWADI MOSHI PUNE 412105
Mobile/Tel No. 8208043998
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number K9919325
Date of Issue 12/03/2013
Date of Expiry 11/03/2023
Place of Issue PUNE
File Number PN1060679872612
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 PUNE
Date 11/05/2024

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