Scribd
Upload
1 views

View_Print Submitted Form

The document is a passport application form for Thanoj Kumar M, applying for a fresh normal passport. It includes personal details such as date of birth, address, and family information, along with a declaration of allegiance to India and the authenticity of the provided information. The application is submitted with necessary enclosures and a payment of Rs. 1500 made via UPI.

Uploaded by

thanojkumarmt
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
1 views

View_Print Submitted Form

The document is a passport application form for Thanoj Kumar M, applying for a fresh normal passport. It includes personal details such as date of birth, address, and family information, along with a declaration of allegiance to India and the authenticity of the provided information. The application is submitted with necessary enclosures and a payment of Rs. 1500 made via UPI.

Uploaded by

thanojkumarmt
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

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 25-1002071351

Applying For FRESH

Type of Application NORMAL

Type of Passport Booklet NORMAL

Applicant Details

Applicant's Name THANOJKUMAR M

Date of Birth (DD/MM/YYYY) 25/07/1998

Validity Required NA

Place of Birth (Village/Town/City) KAMALASHILE

District UDUPI

State/UT KARNATAKA

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

Citizenship of India by BIRTH

Voter Id TZU4872115

Employment Type PRIVATE

Is either of your parent (in case of


N
minor)/spouse, a government servant?

Educational Qualification GRADUATE AND ABOVE

Are you eligible for Non-ECR category? Y

Aadhaar Number 230887627872

Family Details

Father's Name MAHABALA KOTARI

Mother's Name VANAJA KOTARTHI

Present Residential Address Details

Address 1-1 MATADAMAKKI, KAMALASHILE, UDUPI, KARNATAKA


PIN 576229

Police Station SHANKARANARAYANA

Mobile/Tel No. 9108820561

E-mail [email protected]

Permanent Residential Address

Address 1-1 MATADAMAKKI, KAMALASHILE, UDUPI, KARNATAKA

PIN 576229

Police Station SHANKARANARAYANA

Mobile/Tel No. 9108820561

Emergency Contact Details

MANOJ KUMAR M 1/1,MATADAMAKKI


Name and Address
,KAMALASHILE,KUNDAPURA,UDUPI,576229

Mobile/Tel No. 7760184203

E-mail [email protected]

Other Details
Payment Details

Mode of Payment UPI

Date 18/02/2025

Receipt/Reference No. CPAEVEWIM1

Amount Received (Rs.) 1500.00 (ONE THOUSAND FIVE HUNDRED ONLY)

Enclosures

1.Election Photo Identity Card issued by the Election Commission of India containing the date of birth of the applicant

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 UDUPI Signature/Left Hand Thumb Impression of


Applicant (If applicant is minor, either parent
Date 16/02/2025 to sign)

Print Close

You might also like