3/11/2014 Application Form

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Passport Application
Government of India, Ministry of External Affairs
Online Application Receipt
ATM facility available in PSK
for all Bank Cards
Applicant Details :
Application Reference No 14-0001218200
Batch 10
Sequence No. 1
Reporting Time 11:30 AM
Service Type FRESH
Type of Application Normal
Application Submitted Date 02/02/2014
Date of Birth 31/10/1990
Gender FEMALE
Employment Type NOT EMPLOYED
Marital Status SINGLE
Place of Birth DELHI,NEW
DELHI,DELHI
Given Name MADHUSMITA
Surname TIWARI
Father's Name RAMESH TIWARI
Mother's Name ANURADHA TIWARI
Present Address 1206, SECTOR-9 VASUNDHARA, GHAZIABAD, GHAZIABAD - 201012, UTTAR PRADESH, INDIA
Applicants References :
First Reference Details SANJAY SINGH HOUSE NO-1204 SECTOR 9 VASUNDHARA GHAZIABAD U.P, 8826236237
Second Reference Details SATISH RATHI HOUSE NO- 1085 SECTOR-9 VASUNDHARA GHAZIABAD U.P, 9650509222

Payment Details:
#
Total Fee (Rs.) 2000.00
Paid Fee (Rs.) 2000.00
Date and Time 11/03/2014 07:00 PM
Transaction Id CP05310273

Appointment Details :
PSK Location
Ghaziabad,
PASSPORT SEVA KENDRA, BLOCK-A
GROUND FLOOR, PACIFIC BUSINESS
PARK, PLOT NO 37/1, SITE IV,
SAHIBABAD INDUSTRIAL AREA,
GHAZIABAD - 201010
Date & Time of Appointment 25/04/2014 & 11:45 AM
Appointment Id 100004871252914
Reporting Time 11:30 AM



Note:
Applicant should reach the Passport Seva Kendra by the reporting time mentioned above for pre-checking of documents
to avoid any hassles in issuance of token.
Applicant should bring all the originals and one set of photo copy, photo copies should be self attested by the applicant.
One accompanying person from the family will be allowed along with Senior Citizens, Physically Challenged, Illiterate and
Minor applicants only.
Applicant will not be issued token at Passport Seva Kendra, if they report after scheduled appointment time.
Minor applicants below 4 years of age need to carry a recent coloured passport size (4.5 x 3.5 cm) photograph with a white
background while visiting Passport Seva Kendra. Other applicants need not carry any photograph as photograph will be
captured at the Passport Seva Kendra.
Carrying of corrosive substances or explosives, arms or any sharp objects which may cause physical harm or violence are
prohibited inside the PSK. Electronic item such as camera is prohibited inside the PSK.
Balance fee (if applicable) after editing the submitted form will be payable in cash at the Passport Seva Kendra.
# Details as per the Payment Date. Payment once made for availing passport services will not be refunded.