PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External

Service Required
Application Reference Number 24-0009712606
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name GAURAV SINGH BHADORIA
Date of Birth (DD/MM/YYYY) 01/01/2002
Validity Required NA
Place of Birth (Village/Town/City) MAINPURI
District MAINPURI
State/UT UTTAR PRADESH
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN FTHPB6959Q
Employment Type PRIVATE
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? N
Visible Distinguishing Mark RIGHT HAND BURN
Aadhaar Number 831320186432
Family Details
Father's Name MEHTAB SINGH
Mother's Name KESHAV DEVI
Present Residential Address Details
01 POWER HOUSE ROAD MAINPURI, MAINPURI,
Address
MAINPURI, UTTAR PRADESH
PIN 205001
Police Station KOTWALI
Mobile/Tel No. 9354065608
E-mail [email protected]
Permanent Residential Address
01 POWER HOUSE ROAD MAINPURI, MAINPURI,
Address
MAINPURI, UTTAR PRADESH
PIN 205001
Police Station KOTWALI
Mobile/Tel No. 9354065608
Emergency Contact Details
Name and Address KISHAN KUMAR CHAUHAN
Mobile/Tel No. 8171054441
Other Details

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 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 MAINPURI
Date 03/06/2024
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