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Citizenship of India by BIRTH Employment Type Is either of your parent (in case of minor)/ spouse, a government servant? Educational Qualification 10TH PASS AND ABOVE Family Details Father's Name Mother's Name Present Address Details Residing Since(MM/YYYY) Address PIN Mobile/Tel No Email First Reference Name And Address Second Reference Name And Address Permanent Address Address PIN Mobile/Tel No Emergency Contact Details Name and Address
11/1991 5/124 SHANTHINAGAR 3RD STREET MUTHIAPURAM TAMIL NADU THOOTHUKUDI MUTHIAPURAM THOOTHUKUDI 628005 9952220004 GREENBABERAM@gmail.com SUDALAIMUTHU 5/125 SHANTHINAGAR 3RD STREET MUTHIAPURAM POST THOOTHUKUDI-5 THOMAS ANNASAMY 5/127 SHANTHINAGAR 3RD STREET MUTHIAPURAM POST THOOTHUKUDI-5 5/124 SHANTHINAGAR 3RD STREET MUTHIAPURAM TAMIL NADU THOOTHUKUDI MUTHIAPURAM THOOTHUKUDI 628005 9952220004 RAMKUMAR 5/124 SHANTHINAGAR 3RD STREET MUTHIAPURAM POST THOOTHUKUDI-5 Email GREENBABERAM@gmail.com
Mobile/Tel No 9952220004 Other Details Self Declaration I owe allegiance to the sovereignty, unity and 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 and I affirm that the information given by me in this form and the enclosures is true and I am solely responsible for its accuracy, and 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. Place THOOTHUKUDI Date 24/07/2012
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