aro8 ‘Aeplicaion Form 2 PASSPORT APPLICATION FORM Government of INDIA, Ministry of External Affairs Application Reference Number ‘Applying For ‘Type of Application ‘Type of Passport Booklet Applicant's Name Date of Birth (DDIMMIYYYY) Validity Required Place of Birth (Village/Town/City) District State/UT County Gender Marital Status Citizenship of India by PAN Voter id Employment Type. Is either of your parent (in case of minor)/spouse, @ ‘government servant? Educational Qualification ‘Are you eligible for Non-ECR category? ‘Aadhaar Number Father's Name Mother's Name Residing Since(MMIYYYY) Address. PIN Mobile/Tel No. E-mail Address PIN Mobile/Tel No. Name and Address Mobile/Tel No. E-mail 1.Aadhaar Cardi€-Aadhaar 2.Aadhaar Card 18-10036291 FRESH NORMAL JUMBO SOMASHEKHARA SHRISHAILA PATTANASHETTI 20/07/1995 NA GANI \VWAYAPURA KARNATAKA, INDIA MALE SINGLE BIRTH CKAPP7135H XHY2782860 NOT EMPLOYED N GRADUATE AND ABOVE Y 235613545922 ‘SHRISHAILA TIPPANNA PATTANASHETTI KAMALA SHRISHAILA PATTANASHETTI o7iig9s ATIPOST.GANI T:BASAVAN BAGEWADI, GANI, NIDAGUNDI, \VWAYAPURA, KARNATAKA, 586201 8884156649 ‘SPSOMASHEKHAR2170@GMAIL.COM ATIPOST.GANI TO:BASAVAN BAGEWADI, GANI, NIDAGUNDI \VWAYAPURA, KARNATAKA, 586201 8884156649 ‘SOMASHEKHARA PATTANASHETTI 8884156649 ‘SPSOMASHEKHAR2170@GMAIL.COM lowe allegiance to the sovereignty, unity and integrity of India, and have not voluntarily acquired citizenship or travel document of any other county. | 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 rue and | am solely responsible for its accuracy, and | am liable to be penalized or prosecuted iffound otherwise. lam aware that under the Passports Act, 1967 itis a criminal offence to furnish any false information or to suppress any material information with a view to obtaining passport or travel document. Place Date BENGALURU o7iaz018 hips: portal2 passpartinda.govinlAppOnlineProjectlsecuralApplicartSelfDeclarationAction "