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Application Form

The document is an application form for an Indian passport submitted by Tripty Kumar. It provides her personal details like name, date of birth, address, family details, educational qualifications, and employment. It also lists the documents submitted along with the application and includes a self-declaration signed by the applicant.

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tripty
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
31 views

Application Form

The document is an application form for an Indian passport submitted by Tripty Kumar. It provides her personal details like name, date of birth, address, family details, educational qualifications, and employment. It also lists the documents submitted along with the application and includes a self-declaration signed by the applicant.

Uploaded by

tripty
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Application Form https://portal1.passportindia.gov.in/AppOnlineProject/secure/Applicant...

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-0003162900
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name TRIPTY KUMARI
Date of Birth (DD/MM/YYYY) 06/08/1992
Validity Required NA
Place of Birth (Village/Town/City) BIHAR SHARIF
District NALANDA
Region/Country INDIA
Gender FEMALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN DEKPK9666H
Voter Id TGK1436484
Employment Type GOVERNMENT
Organisation name GOVERNMENT POLYTECHNIC, NAWDA, BIHAR
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark MOLE ON CHICK
Aadhaar Number 500555336975
Family Details
Father's Name PRAMOD KUMAR
Mother's Name SUSHMA KUMARI
Spouse's Name MANISH KUMAR
Present Residential Address Details
HOUSE NO:372, WARD NO: 30, HAJIPUR, KHANDAKPER, BIHAR SHARIF,
Address
NALANDA, BIHAR
PIN 803101
Police Station BIHAR
Mobile/Tel No. 7061650605
E-mail [email protected]
Permanent Residential Address
HOUSE NO:372, WARD NO: 30, HAJIPUR, KHANDAKPER, BIHAR SHARIF,
Address
NALANDA, BIHAR
PIN 803101
Police Station BIHAR
Mobile/Tel No. 7061650605
Emergency Contact Details
Name and Address MANISH KUMAR, JEHANABAD
Mobile/Tel No. 8695228957
Other Details
Enclosures
1.Birth certificate issued by the Registrar of Births and Deaths or the Municipal Corporation or any other prescribed authority
whosoever has been empowered under the Registration of Birth and Deaths Act, 1969 to register the birth of a child born in India
2.Aadhaar Card (Address Proof)
3.Identity Certificate in original as per Annexure A
4.No Objection Certificate (NOC) as per Annexure G

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Application Form https://portal1.passportindia.gov.in/AppOnlineProject/secure/Applicant...

5.Prior Intimation Letter (PI) as per Annexure H


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 BIHAR SHARIF
Date 19/02/2024

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