1/3/25, 3:16 PM Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 25-1000112035
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name ABDUL ALEEM MOHAMMED
Date of Birth (DD/MM/YYYY) 26/07/2004
Validity Required NA
Place of Birth (Village/Town/City) HYDERABAD
District HYDERABAD
State/UT TELANGANA
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
Employment Type PRIVATE
Is either of your parent (in case of minor)/spouse, a government
N
servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 367463849691
Family Details
Father's Name MOHAMMED ABDUL NAYEEM
Mother's Name NASREEN BEGUM
Present Residential Address Details
Address 18-8-243/A/52/1, FATEHSHAH NAGAR, EDI BAZAR, HYDERABAD, TELANGANA
PIN 500023
Police Station BHAVANINAGAR
Mobile/Tel No. 8019274805
E-mail [email protected]
Permanent Residential Address
Address 18-8-243/A/52/1, FATEHSHAH NAGAR, EDI BAZAR, HYDERABAD, TELANGANA
PIN 500023
Police Station BHAVANINAGAR
Mobile/Tel No. 8019274805
Emergency Contact Details
Name and Address MOHAMMED ABDUL NAYEEM
Mobile/Tel No. 8500082183
Other Details
Enclosures
1.Birth certificate issued by the Registrar of Births and Deaths or the Municipal Corporation or any other prescribed authority whosoever has been
empowered under the Registration of Birth and Deaths Act, 1969 to register the birth of a child born in India
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 HYDERABAD
Date 03/01/2025

https://portal2.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 1/1