8/20/2014 Application Form

Passport Application
Government of India, Ministry of External Affairs
Online Application Receipt
Applicant Details:
Application Reference No. 14-1007063965
Service Type FRESH
Type of Application Normal
Application Submitted Date 20/08/2014
Date of Birth 10/11/1992
Gender MALE
Employment Type STUDENT
Marital Status SINGLE
Place of Birth NETURIA,PURULIA,WEST
BENGAL
Given Name CHIRAG
Surname CHAKRABORTY
Father's Name G C CHAKRABORTY
Mother's Name CHINMOYEE CHAKRABORTY
Present Address ROOM NO-110,J.C. BOSE BOYS HOSTEL, UIT-BU, BURDWAN, BARDHAMAN, 713104, WEST
BENGAL, INDIA
Applicants References:
First Reference Details G.C. CHAKRABORTY, B-05, C.W.S COLONY, JAYANT, DIST- SINGRAULI (M.P.), PIN-486890,
9425390281
Second Reference Details TANMOY CHAKRABORTY, VILLAGE-NETURIA, PO- NETURIA, DIST. PURULIA (W.B.), PIN-
723121, 8348244057

Payment Details:#
Payment Status Not paid

Appointment Details:
PSK Location
Date and Time of Appointment
Appointment Id
Reporting Time

Note:
Applicant should reach the Passport Seva Kendra by the reporting tim e m entioned above for pre-checking of docum ents
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 accom panying person from the fam ily w ill be allow ed along w ith Senior Citizens, Physically Challenged, Illiterate and
Minor applicants only.
Applicant w ill not be issued token at Passport Seva Kendra, if they report after scheduled appointm ent tim e.
Minor applicants below 4 years of age need to carry a recent coloured passport size (4.5 x 3.5 cm ) photograph w ith a w hite
background w hile visiting Passport Seva Kendra. Other applicants need not carry any photograph as photograph w ill be
captured at the Passport Seva Kendra.
Carrying of corrosive substances or explosives, arm s or any sharp objects w hich m ay cause physical harm or violence are
prohibited inside the PSK. Electronic item such as cam era is prohibited inside the PSK.
# Details as per the Payment Date. Payment once made for availing passport services will not be refunded.

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