12/4/2018 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 18-0018122896
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name AMIT KUMAR
Date of Birth (DD/MM/YYYY) 30/06/1997
Validity Required NA
Place of Birth (Village/Town/City) NO
District YAMUNANAGAR
State/UT HARYANA
Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN CLWPA3683A
Employment Type PRIVATE
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark HAVE ON RIGHT HAND CHEST
Aadhaar Number 331636552052
Family Details
Father's Name KHARAG SINGH
Mother's Name SEEMA RANI
Present Residential Address Details
1068 DAGAN STREET BRAHMAN CHOWK, JAGADHRI, CITY JAGADHRI,
Address
YAMUNANAGAR, HARYANA
PIN 135001
Mobile/Tel No. 7206601810
E-mail AAAAAMITK85@GMAIL.COM
Emergency Contact Details
Name and Address AMIT KUMAR
Mobile/Tel No. 7206601810
E-mail AAAAAMITK85@GMAIL.COM
Other Details
Enclosures
1.Aadhaar Card/E-Aadhaar
2.Rent Agreement
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 JAGADHRI
Date 04/12/2018

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