10/25/2017 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 17-0014896672
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name AKHILESH
Date of Birth (DD/MM/YYYY) 23/11/1997
Validity Required NA
Place of Birth (Village/Town/City) SRI GANGANAGAR
District SRI GANGANAGAR
State/UT RAJASTHAN
Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
Employment Type STUDENT
Is either of your parent (in case of minor)/spouse,
Y
a government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark CUT MARK ON 1ST FINGURE OF LEFT HAND
Aadhaar Number 859703622325
Family Details
Father's Name MOHAN LAL MAHAR
Mother's Name SUMITRA MAHAR
Present Residential Address Details
Residing Since(MM/YYYY) 12/1997
H.NO. 514 MAIN ROAD,SHAKTI NAGAR,OLD ABADI, SRI GANGANAGAR, PURANI
Address
ABADI, SRI GANGANAGAR, RAJASTHAN
PIN 335001
Mobile/Tel No. 9509150986
E-mail AKHILESH.MAHAR123@GMAIL.COM
First Reference Name And Address MOHAN LAL MAHAR H.NO. 514 MAIN ROAD , SHAKTI NAGAR , OLD ABADI
Mobile/Tel No. 9414220554
Second Reference Name And Address SUMITRA MAHAR H.NO. 514 MAIN ROAD , SHAKTI NAGAR , OLD ABADI
Mobile/Tel No. 9509592950
Permanent Residential Address
H.NO. 514 MAIN ROAD,SHAKTI NAGAR,OLD ABADI, SRI GANGANAGAR, PURANI
Address
ABADI, SRI GANGANAGAR, RAJASTHAN
PIN 335001
Mobile/Tel No. 9509150986
Emergency Contact Details
Name and Address MOHAN LAL MAHAR
Mobile/Tel No. 9414220554
Mobile/Tel No. 9414220554
Other Details
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 SRI GANGANAGAR
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10/25/2017 Application Form
Date 25/10/2017

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