Application Form 26/04/24, 3:16 AM

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-0007278118
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name NEHA
Date of Birth (DD/MM/YYYY) 03/04/2002
Validity Required NA
Place of Birth (Village/Town/City) AMBALA CITY
District AMBALA
State/UT HARYANA
Region/Country INDIA
Gender FEMALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN CHRPN0802P
Voter Id NGD1408061
Employment Type STUDENT
Is either of your parent (in case of minor)/spouse, a government
N
servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 712024892787
Family Details
Father's Name SURESH KUMAR KALRA
Mother's Name MEENU BALA
Present Residential Address Details
187,SARASWATI NAGAR, AMBALA CITY, AMBALA,
Address
HARYANA
PIN 134003
Police Station AMBALA CITY
Mobile/Tel No. 7206169310
E-mail [email protected]
Permanent Residential Address
187,SARASWATI NAGAR, AMBALA CITY, AMBALA,
Address
HARYANA
PIN 134003
Police Station AMBALA CITY
Mobile/Tel No. 7206169310
Emergency Contact Details
Name and Address SURESH KUMAR KALRA
Mobile/Tel No. 9896376619
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

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Application Form 26/04/24, 3:16 AM

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 AMBALA CITY
Date 26/04/2024

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