24/12/2019 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 19-1012281663
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name PRITAM SINGHA
Date of Birth (DD/MM/YYYY) 28/06/2000
Validity Required NA
Place of Birth (Village/Town/City) KOLKATA
District PURBA BARDHAMAN
State/UT WEST BENGAL
Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN JBFPS6006H
Voter Id AQT2086775
Employment Type STUDENT
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 MOLE ON RIGHT CHEEK
Aadhaar Number 759280865422
Family Details
Father's Name PRATAP KUMAR SINGHA
Mother's Name BULA SINGHA
Present Residential Address Details
GHATAKPARA , KALNA, KALNA, PURBA BARDHAMAN, WEST
Address
BENGAL
PIN 713409
Police Station KALNA
Mobile/Tel No. 7001242564
E-mail PRITAMSINGHA68@GMAIL.COM
Permanent Residential Address
GHATAKPARA , KALNA, KALNA, PURBA BARDHAMAN, WEST
Address
BENGAL
PIN 713409
Police Station KALNA
Mobile/Tel No. 7001242564
Emergency Contact Details
PRATAP KUMAR SINGHA , GHATAKPARA , KALNA , PURBA
Name and Address
BURDWAN , PIN-713409
Mobile/Tel No. 8017381140
E-mail PRATAP.SINGHA2016@GMAIL.COM
Other Details
Enclosures
1.Aadhaar Card/E-Aadhaar
2.Aadhaar Card/e-Aadhar containing the 12 digit Aadhaar number issued by the Unique Identification Authority of India(UIDAI)
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 KALNA , PURBA BURDWAN
Date 24/12/2019
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24/12/2019 Application Form

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