12/8/2014

ApplicationForm

PassportApplication
ATMfacilityavailableatPSK
GovernmentofIndia,MinistryofExternalAffairs
forallBankCards
OnlineApplicationReceipt
ApplicantDetails:
ApplicationReferenceNo. 140012743702
ServiceType
FRESH
Batch
3
TypeofApplication
Tatkaal
SequenceNo.
7
ApplicationSubmittedDate 06/12/2014
DateofBirth
15/06/1994
ReportingTime 09:45AM
Gender
MALE
EmploymentType
STUDENT
MaritalStatus
SINGLE
PlaceofBirth
MUMBAI,MUMBAI,MAHARASHTRA
GivenName
NEELJAIPRAKASH
Surname
SHARMA
Father'sName
JAIPRAKASHRAMNAYANSHARMA
Mother'sName
APARNAJAIPRAKASHSHARMA
PresentAddress
203,SHIVSHANKARTOWERPLOT55,SECTOR20/B,AIROLI,NAVIMUMBAI,NAVIMUMBAI,
400708,MAHARASHTRA,INDIA
ApplicantsReferences:
FirstReferenceDetails
MARUTIPAWAR,1101,SHIVSHANKARTOWER,PLOTNO55,SECTOR20/B,AIROLI,NAVI
MUMBAI,400708,9223287479
SecondReferenceDetails GOWARDHANBORKAR,201,SHIVSHANKARTOWER,PLOTNO55,SECTOR20/B,AIROLI,
NAVIMUMBAI,400708,9004146789

PaymentDetails:#
TotalFee(Rs.)
3500.00
PaidFee(Rs.)
1500.00
DateandTime
08/12/201403:16PM
TransactionId
CP12099159

AppointmentDetails:
Thane,
PASSPORTSEVAKENDRA,DOSTI
PSKLocation
PINNACLE,UNITNOG1,PLOTNO
E7,ROADNO22,WAGLEINDUSTRIAL
ESTATE,THANEWEST400604
DateandTimeof
10/12/2014&10:00AM
Appointment
AppointmentId
100005886188314
ReportingTime
09:45AM
AppointmentQuota
Tatkaal

Thanksforshowingyourinterestin'PassportSevaSMSServices'enrolment.PleasepayRs30/(THIRTYONLY)incashasthe
EnrolmentChargesduringyourvisittoPassportSevaKendra.

Note:
Applicant should reach the Passport Seva Kendra by the reporting time mentioned above for prechecking of documents to
avoidanyhasslesinissuanceoftoken.
Applicantshouldbringalltheoriginalsandonesetofphotocopy,photocopiesshouldbeselfattestedbytheapplicant.
OneaccompanyingpersonfromthefamilywillbeallowedalongwithSeniorCitizens,PhysicallyChallenged,IlliterateandMinor
applicantsonly.
ApplicantwillnotbeissuedtokenatPassportSevaKendra,iftheyreportafterscheduledappointmenttime.
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
capturedatthePassportSevaKendra.
Carrying of corrosive substances or explosives, arms or any sharp objects which may cause physical harm or violence are
prohibitedinsidethePSK.ElectronicitemsuchascameraisprohibitedinsidethePSK.
Applicantsapplyingunder"TATKAAL"schememaypleasenotethattheirapplicationprocessingatPassportSevaKendramay
take approximately 2 hours due to additional verifications required before processing of such applications. Therefore,
"TATKAAL"applicantsareadvisedtoplantheirscheduleaccordingly.
Balancefee(ifapplicable)aftereditingthesubmittedformwillbepayableincashatthePassportSevaKendra.

#DetailsasperthePaymentDate.Paymentoncemadeforavailingpassportserviceswillnotberefunded.

https://portal1.passportindia.gov.in/AppOnlineProject/secure/openPdfForApplReciept

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ApplicationForm

ThefollowingtablelistsApplicantCategoriesalongwiththeDocumentstobeSubmitted.TheDocumentNo.mentionedin
DocumentstobeSubmittedcolumnisthereferencegiventothedocumentmentionedinListofDocumentstable.

ApplicantCategories

DocumentstobeSubmitted

OrdinaryCase(CitizenofIndiabybirth)

(i)1,2,3(iftheapplicantiseligibleforNonECR),19
(ii)18or21

CitizenofIndiabyDescent(BorntoIndianparent(s)outsideIndia)

CannotapplyunderTatkaalScheme

CitizenofIndiabyRegistration/Naturalization(GrantedcitizenshipbyMHA)

CannotapplyunderTatkaalScheme

ApplicantsrepatriatedfromabroadatGovernmentcost

CannotapplyunderTatkaalScheme

ApplicantsdeportedtoIndia/EmergencyCertificatecases

CannotapplyunderTatkaalScheme

Government/PublicSector/Statutorybodyemployees

(i)1,2
(ii)15(ifNoPoliceVerificationisrequired)or14(ifPostPoliceVerificationis
required)

DependentfamilymembersofGovernment/PublicSector/Statutorybody
employees(ForJ&Kchildreninagegroup1015yearsarecovered.Forrestof
Indiachildreninagegroup1821arecovered)

(i)1,2,3(iftheapplicantiseligibleforNonECR),19
(ii)15(ofdependent)or18or21

Retiredgovernmentofficials

(i)1,2,19
(ii)5or18or21

(i)1,2,6(7ifsurrendercertificateisnotavailable),19
(ii)15or14ifapplicantisGovernment/PublicSector/Statutorybodyemployee
ApplicantshavingDiplomatic/OfficialPassportandapplyingforordinaryPassport
(iii)18or21ifapplicantisnotaGovernment/PublicSector/Statutorybody
whileinservice
employee
Note:Incasetheapplicantsubmits"7","2"isnotrequired
DependentfamilymembersofDiplomatic/OfficialPassportholderswhoarenot
governmentservants(ForJ&KChildreninagegroup1015yearsarecovered)

(i)1,2,3(iftheapplicantiseligibleforNonECR),22,19
(ii)18or21

Owner,partnersanddirectorsofCompanieswhicharemembersofCII,FICCI&
ASSOCHAM.

(i)1,2,19
(ii)20or21

Minorchangeinname

(i)1(innewname),2(inoldname),3(iftheapplicantiseligibleforNonECR
Documentsinoldnameareallowed),17,19
(ii)18or21

Majorchangeinname

CannotapplyunderTatkaalScheme

Change/Additioninsurnameduetomarriage

(i)1,2,3(iftheapplicantiseligibleforNonECR),19
(ii)8or16
(iii)18or21

ChangeinnameincaseofGovernment/PublicSector/Statutorybodyemployees

(i)1,2,9,10,17,19
(ii)18or21

NagalandResidents

CannotapplyunderTatkaalScheme

NagaoriginsresidingoutsideNagaland

CannotapplyunderTatkaalScheme

JammuandKashmirResidents

CannotapplyunderTatkaalScheme
Note:MandatoryPrePoliceVerificationrequired

JammuandKashmirResidentsstayingoutsideJ&Kformorethanfiveyears

(i)1,2,3(iftheapplicantiseligibleforNonECR),19
(ii)18or21
(iii)Proofofregistration/Migrationcertificate

Studentsstayingawayfromtheirparent'scurrentresidence

(i)1,2,3(iftheapplicantiseligibleforNonECR),11,12,19
(iii)18or21

SeniorCitizens(ForJ&K:Men65+years,Women60+yearsForrestofIndia
65+years)

(i)1,2,3(iftheapplicantiseligibleforNonECR),19
(ii)13or18or21

Document
No.

ListofDocuments
ProofofPresentAddress.ForProofofAddressattachoneofthefollowingdocuments:

1.

a. Waterbill/Telephone(landlineorpostpaidmobilebill)/Electricitybill(atleast2billsarerequiredOnebillshouldofbeoflastyearandthe
otherbillofcurrentyear)
b. Oneyearstatement(withtransactions)/Passbookofrunningbankaccount(PublicSectorBanksonly)
c. IncomeTaxAssessmentOrder
d. ElectionCommissionPhotoIDcard
e. Gasconnectionbill
f. CertificatefromEmployerofreputedandwidelyknowncompaniesonletterhead(Onlypubliclimitedcompaniescangiveaddressproofon
companyletterheadalongwithseal.Computerisedprintoutsshallnotbeentertained)
g. Spouse'spassportcopy(Firstandlastpageincludingfamilydetails),(providedtheapplicant'spresentaddressmatchestheaddress
mentionedinthespouse'spassport)
h. Applicant'scurrentandvalidrationcard
NOTE1:Ifanyapplicantsubmitsonlyrationcardasproofofaddress,itshouldbeaccompaniedbyonemoreproofofaddressoutofthe
givencategories.
i. Parent'spassportcopy,incaseofminors(Firstandlastpage)
j. AadhaarLetter/Card(IfaadhaarcardissuancedateislessthanayearfrompassportapplicationprocessingdateatPSK,itshouldbe
accompaniedbyonemoreproofofaddressoutofthegivencategories)
k. RegisteredRentAgreement(foraperiodofmorethanoneyear)
ProofofDateofBirth.ForProofofDateofBirthattachoneofthefollowingdocuments:
a. BirthcertificateissuedbyaMunicipalAuthorityoranyofficeauthorizedtoissueBirthandDeathCertificatebytheRegistrarofBirths&
Deaths
b. Schoolleavingcertificate/SecondarySchoolleavingcertificate/CertificateofRecognizedBoardsfromtheschoollastattendedbythe
applicantoranyotherrecognizededucationalinstitution

https://portal1.passportindia.gov.in/AppOnlineProject/secure/openPdfForApplReciept

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ApplicationForm
2.

c. AffidavitswornbeforeaMagistrate/Notarystatingdate/placeofbirthasperthespecimeninAnnexure"A"byilliterateorsemiilliterate
applicants(Lessthan5thclass).
Forapplicantsbornonorafter26.01.89,onlyBirthCertificateissuedbytheMunicipalAuthorityoranyofficeauthorizedtoissueBirthandDeath
CertificatebytheRegistrarofBirths&Deathsisacceptable.TheBirthCertificateshouldordinarilycontainthenameofchild,nameoffatherand
mother,dateofbirth,placeofbirth,sex,registrationnumberanddateofregistration.IftheBirthCertificatedoesn'tcontainthenameofchild,a
declarationonplainpapersignedbyparents,isrequiredtobesubmittedspecifyingthenameofthechild.

3. DocumentaryproofforanyoneoftheNonECR(previouslyECNR)categories,ReferColumn2.15underSectionBofpassportinstructionbooklet
4.

OldPassportinoriginalwithselfattestedphotocopyofitsfirsttwoandlasttwopages,includingECR/NonECRpage(previouslyECNR)andthepage
ofobservation(ifany),madebyPassportIssuingAuthorityandvalidityextensionpage,ifany,inrespectofshortvaliditypassport

5. PensionPaymentOrder
6. ProofofsurrenderorcancellationofDiplomatic/officialPassport
7. CancelledPassport(ifsurrendercertificateisnotavailable),withaletterexplainingwhysurrendercertificateisnotavailable
8. AnattestedcopyofmarriagecertificateissuedbyRegistrarofMarriage
9. GazetteNotificationchangingnameinapplicant'sdepartment
10. FreshIDCertificateinchangedname
11. StudentIdentityCardissuedbyGovernmentRecognizedEducationalInstitutions,inrespectoffulltimecourses
12. BonafideLetterfromauthorizedsignatoryofcollege(OnofficialletterheadofUGCrecognizedCollege)
13. Copyofchild's(Age>18)Passport,whoisstayingabroad(withpagehavingparent'sname)
14. NoObjectionCertificate(NOC)(asperAnnexure'M')
15. "IdentityCertificate"inoriginalasperAnnexure"B"
16.

Ajointaffidavitfromhusbandandwifealongwithajointphotograph,(SpecimenatAnnexure"D")Whenjointaffidavitisnotpossibletheaffidavit
shouldindicatethereasonforit.Ifapplyingforpassportforthefirsttime,thisaffidavitisrequiredonlyifthereisachangeinthefirstname.

17. Deedpoll/swornaffidavitasperAnnexure"E"
18. VerificationCertificateasperthespecimenasperAnnexure"F"
19. StandardAffidavitasperAnnexure"I"
20. VerificationCertificateasperAnnexure"J"
3outof16documentslistedareasunder:

21.

a. ElectorsPhotoIdentityCard(EPIC)
b. ServicePhotoIdentityCardissuedbyState/CentralGovernment,PublicSectorUndertakings,localbodiesorPublicLimitedCompanies
c. SC/ST/OBCCertificates
d. FreedomFighterIdentityCards
e. ArmsLicenses
f. PropertyDocumentssuchasPattas,RegisteredDeedsetc.
g. RationsCards
h. PensionDocumentssuchasexservicemen'sPensionBook/PensionPaymentorder,exservicemen'sWidow/DependentCertificates,Old
AgePensionOrder,WidowPensionOrder
i. RailwayIdentityCards
j. IncomeTaxIdentity(PAN)Cards
k. Bank/Kisan/PostOfficePassbooks
l. StudentPhotoIdentityCardsissuedbyGovernmentRecognizedEducationalInstitutionsinrespectoffulltimecourses
m. DrivingLicenses(validandwithinthejurisdictionofStateofsubmissionofapplication)
n. BirthCertificatesissuedundertheRBDAct
o. GasConnectionBill(ofoneyearbeforeandcurrentbill)
p. AadhaarLetter/Card
NOTE2:(i)Forthreedocumentstobesubmittedfromthesixteendocumentslistedabove,oneofthethreedocumentsshouldbeaphotoidentity
documentandatleastoneofthethreemustbeamongstthedocumentsindicatedat(a)to(i)above
(ii)Nameinallthethreedocumentsshouldbesame
(iii)Allabovedocumentsarerequiredtobeproducedinoriginalalongwithselfattestedcopies.

22. PhotocopyofDiplomatic/OfficialPassport

Note:Thelistofdocumentsprovidedinthetableaboveisindicative.ThedecisionofAPO/RPOshallbeconsideredfinal.

https://portal1.passportindia.gov.in/AppOnlineProject/secure/openPdfForApplReciept

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