2/6/2020 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 20-0001884796
Applying For REISSUE
If Re-issue, specify reason(s) VALIDITY EXPIRED WITHIN 3 YEARS/DUE TO EXPIRE.
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name KOMAL NANDA
Date of Birth (DD/MM/YYYY) 23/02/1994
Validity Required NA
Place of Birth (Village/Town/City) GANDHIDHAM
District EAST-KUTCH GANDHIDHAM
State/UT GUJARAT
Country INDIA
Gender FEMALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN ARFPN6645N
Employment Type HOME MAKER
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark MOLE ON NOSE
Aadhaar Number 617266696861
Family Details
Father's Name SHIVJI BHANJI BHANUSHALI
Mother's Name DIPTIBEN SHIVJI BHANUSHALI
Present Residential Address Details
355-A APNANAGAR,NU-3, GANDHIDHAM, EAST-KUTCH GANDHIDHAM,
Address
GUJARAT
PIN 370201
Police Station GANDHIDHAM A
Mobile/Tel No. 9033836904 / 9033836904
E-mail [email protected]
Permanent Residential Address
355-A APNANAGAR,NU-3, GANDHIDHAM, EAST-KUTCH GANDHIDHAM,
Address
GUJARAT
PIN 370201
Police Station GANDHIDHAM A
Mobile/Tel No. 9033836904 / 9033836904
Emergency Contact Details
KARAN BHANUSHALI, LODHA FIORENZA, BESIDE HUB MALL,CAMA
Name and Address
INDUSTRIAL ESTATE
Mobile/Tel No. 9511661990
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number J2969498
Date of Issue 19/08/2010
Date of Expiry 18/08/2020
Place of Issue AHMEDABAD
File Number AHDZ86581410
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
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2/6/2020 Application Form

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 MUMBAI
Date 06/02/2020
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