Scribd
Upload
24 views2 pages

View - Print Submitted Form

Uploaded by

ravinderbarnala66
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
24 views2 pages

View - Print Submitted Form

Uploaded by

ravinderbarnala66
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
You are on page 1/ 2

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 22-0020182224

Applying For FRESH

Type of Application NORMAL

Type of Passport Booklet NORMAL


Applicant Details

Applicant's Name RAVINDER SINGH

Date of Birth (DD/MM/YYYY) 08/11/2001

Validity Required NA

Place of Birth (Village/Town/City) BARNALA

District BARNALA

State/UT PUNJAB

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

Citizenship of India by BIRTH

PAN NMJPS5513Q

Voter Id XSZ2592848

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

Aadhaar Number 532416263230

Family Details

Father's Name DARSHAN SINGH

Mother's Name SARABJEET KAUR


Present Residential Address Details

Address SOHAL PATTI, BARNALA, BARNALA, PUNJAB

PIN 148107

Police Station CITY BARNALA


Mobile/Tel No. 9417584485

E-mail [email protected]
Emergency Contact Details

Name and Address DARSHAN SINGH SOHAL PATTI BARNALA

Mobile/Tel No. 9463819212


Other Details
Payment Details

Mode of Payment UPI

Date 25/11/2022

Receipt/Reference No. CPACGBWUI0

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


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 BARNALA Signature/Left Hand Thumb Impression of


Applicant (If applicant is minor, either parent
Date 25/11/2022 to sign)

Print Close

You might also like