3/13/25, 5:39 PM Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 25-1003057453
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name VINAY KUMAR POLA
Date of Birth (DD/MM/YYYY) 01/08/1998
Validity Required NA
Place of Birth (Village/Town/City) CHINABONDAPALLI
District PARVATHIPURAM MANYAM
State/UT ANDHRA PRADESH
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN FKHPP5663Q
Voter Id ZAH0906883
Employment Type STUDENT
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
Visible Distinguishing Mark A MOLE ON THE STOMACH
Aadhaar Number 294288545609
Family Details
Father's Name POLINAIDU POLA
Mother's Name JAYALAKSHMI POLA
Present Residential Address Details
2-90B,MAIN ROAD CHINABONDAPALLI M R NAGARAM POST, PARVATHIPURAM,
Address
PARVATHIPURAM MANYAM, ANDHRA PRADESH
PIN 535522
Police Station PARVATHIPURAM RURAL
Mobile/Tel No. 9642670575
E-mail [email protected]
Permanent Residential Address
2-90B,MAIN ROAD CHINABONDAPALLI M R NAGARAM POST, PARVATHIPURAM,
Address
PARVATHIPURAM MANYAM, ANDHRA PRADESH
PIN 535522
Police Station PARVATHIPURAM RURAL
Mobile/Tel No. 9642670575
Emergency Contact Details
Name and Address POLINAIDU
Mobile/Tel No. 9502189799
Other Details
Enclosures
1.Permanent Account Number Card issued by the Income-tax Department having 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

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3/13/25, 5:39 PM 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 PARVATHIPURAM
Date 13/03/2025

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