6/20/22, 11:27 AM Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 22-1006829185
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name KATHIRAVAN E
Date of Birth (DD/MM/YYYY) 20/07/1996
Validity Required NA
Place of Birth (Village/Town/City) SALEM
District NAMAKKAL
State/UT TAMIL NADU
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN AEXPE7844M
Employment Type NOT EMPLOYED
Is either of your parent (in case of minor)/spouse,
N
a government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? N
Aadhaar Number 858366004452
Family Details
Father's Name ELANGOVAN A
Mother's Name ARULMANI E
Present Residential Address Details
4/249-1, KATTU VALAVU, KOKKARAYANPETTAI, KUMARAPALAYAM, NAMAKKAL,
Address
TAMIL NADU
PIN 638007
Police Station MOLASI
Mobile/Tel No. 8675133312
E-mail [email protected]
Permanent Residential Address
4/249-1, KATTU VALAVU, KOKKARAYANPETTAI, KUMARAPALAYAM, NAMAKKAL,
Address
TAMIL NADU
PIN 638007
Police Station MOLASI
Mobile/Tel No. 8675133312
Emergency Contact Details
KATHIRAVAN, 4/249-1, KATTU VALAVU, KOKKARAYANPETTAI (POST),
Name and Address
KUMARAPALAYAM (TALUK), NAMAKKAL (DISTRICT)
Mobile/Tel No. 8675133312
E-mail [email protected]
Other Details
Enclosures
1.Aadhaar Card/E-Aadhaar
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

https://portal2.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 1/2
6/20/22, 11:27 AM Application Form
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 NAMAKKAL
Date 20/06/2022

https://portal2.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 2/2