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View - Print Submitted Form RAMA SINGH

The document is a passport application form submitted by Rama Singh for a fresh normal passport. It includes personal details such as date of birth, address, and family information, as well as a declaration affirming the accuracy of the provided information. The application was submitted on December 14, 2024, with a payment of Rs. 1350 made via UPI.

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amit singh
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22 views2 pages

View - Print Submitted Form RAMA SINGH

The document is a passport application form submitted by Rama Singh for a fresh normal passport. It includes personal details such as date of birth, address, and family information, as well as a declaration affirming the accuracy of the provided information. The application was submitted on December 14, 2024, with a payment of Rs. 1350 made via UPI.

Uploaded by

amit singh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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1/19/25, 9:09 PM View/Print Submitted Form

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 24-0020710442

Applying For FRESH

Type of Application NORMAL

Type of Passport Booklet NORMAL


Applicant Details
Applicant's Name RAMA SINGH

Date of Birth (DD/MM/YYYY) 05/01/1963

Validity Required NA

Place of Birth (Village/Town/City) AGRA

District AGRA

State/UT UTTAR PRADESH

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

Citizenship of India by BIRTH

PAN LTWPS7702M

Employment Type HOME MAKER

Is either of your parent (in case of


N
minor)/spouse, a government servant?

Educational Qualification 7TH PASS OR LESS

Are you eligible for Non-ECR category? Y

Visible Distinguishing Mark BIRTH MARK

Aadhaar Number 451268050206

Family Details
Father's Name RAM JI LAL

Spouse's Name VIJAY SINGH


Present Residential Address Details
44 PUSPKUNJ COLONY MAU ROAD KHANDARI AGRA,
Address
AGRA, AGRA, UTTAR PRADESH

PIN 282005

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1/19/25, 9:09 PM View/Print Submitted Form

Police Station NEW AGRA

Mobile/Tel No. 9548445933

E-mail [email protected]
Permanent Residential Address
44 PUSPKUNJ COLONY MAU ROAD KHANDARI AGRA,
Address
AGRA, AGRA, UTTAR PRADESH

PIN 282005

Police Station NEW AGRA

Mobile/Tel No. 9548445933


Emergency Contact Details
TANU SINGH & 44 PUSPKUNJ COLONY MAU ROAD
Name and Address
KHANDARI AGRA DAYALBAGH 282005

Mobile/Tel No. 9456674243

E-mail [email protected]
Other Details
Payment Details
Mode of Payment UPI

Date 14/12/2024

Receipt/Reference No. CPAEOLPFO9

1350.00 (ONE THOUSAND THREE HUNDRED AND FIFTY


Amount Received (Rs.)
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 AGRA Signature/Left Hand Thumb Impression of


Applicant (If applicant is minor, either parent
Date 14/12/2024 to sign)

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