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APPLICATION FORM - Sajesh

This document is a passport application form for Sajesh Chandu Cheruvayal. It provides his personal details like name, date of birth, place of birth, address, father and mother's name. It specifies that he is applying for a fresh normal passport. It lists the documents enclosed like his 10th class certificate and Aadhaar card. It contains a self-declaration where he declares his allegiance to India and that he has not acquired citizenship of any other country. He affirms that all information provided is true.

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Mohammed Yasir
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21 views

APPLICATION FORM - Sajesh

This document is a passport application form for Sajesh Chandu Cheruvayal. It provides his personal details like name, date of birth, place of birth, address, father and mother's name. It specifies that he is applying for a fresh normal passport. It lists the documents enclosed like his 10th class certificate and Aadhaar card. It contains a self-declaration where he declares his allegiance to India and that he has not acquired citizenship of any other country. He affirms that all information provided is true.

Uploaded by

Mohammed Yasir
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-1000310853
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name SAJESH CHANDU CHERUVAYAL
Date of Birth (DD/MM/YYYY) 30/04/1997
Validity Required NA
Place of Birth (Village/Town/City) MANANTHAVADY
District ERNAKULAM CITY
State/UT KERALA
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN CASPC1975L
Voter Id XYH0974493
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 BLACK MOLE ON RIGHT HAND
Aadhaar Number 428859220120
Family Details
Father's Name CHANDU CHERUVAYAL
Mother's Name THANKAMANI CHERUVAYAL CHANDU
Present Residential Address Details
SAJESH NIVAS,KAMMANA,NALLOORNAD, MANANTHAVADY, WAYANAD,
Address
KERALA
PIN 670645
Police Station MANANTHAVADY
Mobile/Tel No. 8943045535
E-mail [email protected]
Permanent Residential Address
SAJESH NIVAS,KAMMANA,NALLOORNAD, MANANTHAVADY, WAYANAD,
Address
KERALA
PIN 670645
Police Station MANANTHAVADY
Mobile/Tel No. 8943045535
Emergency Contact Details
Name and Address SUMESH
Mobile/Tel No. 8547655864
Other Details
Enclosures
1.Transfer/School leaving/Matriculation Certificate issued by the school last attended/recognized educational board
2.Aadhaar Card (Address Proof)
Self Declaration
I owe allegiance to the sovereignty, unity & 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. I have not contravened any of the conditions relating to
the possession and use of an Indian passport.
I affirm that the information and particulars given by me in this form are true and correct. I further state that I am not suppressing any
material information in this regard. I further affirm that the enclosures and documentary proof submitted in support of my application for
an Indian passport are authentic and solely pertain to me and I am fully responsible for the accuracy of the same. 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.
I have read and understood the contents of the above and by submitting this form certify that all the information submitted by me in the
form is bonafide.
Place MANANTHAVADY
Date 07/01/2024
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