3/20/24, 5:17 PM Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-1003755117
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name RAJESHWARI MAREPALLY
Date of Birth (DD/MM/YYYY) 16/04/1975
Validity Required NA
Place of Birth (Village/Town/City) RAVIRALA
District CYBERABAD-RANGAREDDY
State/UT TELANGANA
Region/Country INDIA
Gender FEMALE
Marital Status MARRIED
Citizenship of India by BIRTH
Employment Type HOME MAKER
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification 7TH PASS OR LESS
Are you eligible for Non-ECR category? N
Visible Distinguishing Mark MOLE ON THE RIGHT SIDE NOSE
Aadhaar Number 804593216450
Family Details
Father's Name CHENNAPPA PALLATI
Mother's Name SARASWATHI PALLATI
Spouse's Name RAMULU MAREPALLY
Present Residential Address Details
5-29/1 RAVICHED THALAKONDAPALLY MANDAL, RAVICHED, CYBERABAD-
Address
RANGAREDDY, TELANGANA
PIN 509408
Police Station KADTHAL
Mobile/Tel No. 9912512539
E-mail [email protected]
Permanent Residential Address
5-29/1 RAVICHED THALAKONDAPALLY MANDAL, RAVICHED, CYBERABAD-
Address
RANGAREDDY, TELANGANA
PIN 509408
Police Station KADTHAL
Mobile/Tel No. 9912512539
Emergency Contact Details
Name and Address RAMULU MAREPALLY / RAVICHED
Mobile/Tel No. 9912512539
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.

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3/20/24, 5:17 PM Application Form
Place RAVICHED
Date 20/03/2024

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