2/1/25, 12:25 PM Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 25-0001880378
Applying For REISSUE
If Re-issue, specify reason(s) CHANGE IN EXISTING PERSONAL PARTICULARS
If change in existing personal particulars, specify SIGNATURE , DELETE ECR
Type of Application TATKAAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name PRAVINKUMAR RANJANSINH BARIA
Date of Birth (DD/MM/YYYY) 10/07/1989
Validity Required NA
Place of Birth (Village/Town/City) CHHAVAD
District PANCHMAHALS
State/UT GUJARAT
Region/Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
Employment Type SELF EMPLOYED
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark NOT APPLICABLE
Aadhaar Number 892423085530
Family Details
Father's Name RANJANSINH BALVANTSINH BARIA
Mother's Name SURAJBEN RANJANSINH BARIA
Spouse's Name SAJANBEN PRAVINKUMAR BARIA
Present Residential Address Details
1-56, BARIA FALIYU, CHHAVAD,TA-GODHRA, PANCHMAHALS,
Address
PANCHMAHALS, GUJARAT
PIN 389120
Police Station GODHRA TALUKA
Mobile/Tel No. 8200989348
E-mail [email protected]
Emergency Contact Details
Name and Address BHAVESH RATHOD
Mobile/Tel No. 8200989348
E-mail [email protected]
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number V4619669
Date of Issue 07/12/2021
Date of Expiry 06/12/2031
Place of Issue AHMEDABAD
File Number AHN065841226621
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 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 PANCHMAHALS
Date 01/02/2025

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