Application Form https://portal2.passportindia.gov.in/AppOnlineProject/secure/Applican...

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-1004238495
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name TANMAY KRISHNA GUMMA
Date of Birth (DD/MM/YYYY) 09/08/2013
Validity Required NA
Place of Birth (Village/Town/City) VELLAM PALLE
District PRAKASAM
State/UT ANDHRA PRADESH
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
Employment Type STUDENT
Is either of your parent (in case of minor)/
N
spouse, a government servant?
Educational Qualification 7TH PASS OR LESS
Are you eligible for Non-ECR category? N
Aadhaar Number 396093404919
Family Details
Father's Name HANUMANTHA RAO GUMMA
Mother's Name UMADEVI GUMMA
Father/Legal guardian's File/Passport
M0561684
Number
Present Residential Address Details
000,KALYANI HOTEL OPPOSITE,TOBOCO BOARD, VELLAMPALLE, PRAKASAM,
Address
ANDHRA PRADESH
PIN 523211
Police Station MADDIPADU
Mobile/Tel No. 7729055556
E-mail [email protected]
Permanent Residential Address
000,KALYANI HOTEL OPPOSITE,TOBOCO BOARD, VELLAMPALLE, PRAKASAM,
Address
ANDHRA PRADESH
PIN 523211
Police Station MADDIPADU
Mobile/Tel No. 7729055556
Emergency Contact Details
S/O HANUMANTHA RAO, 000,KALYANI HOTEL OPPOSITE,TOBOCO BOARD,
Name and Address
VELLAMPALLE VILLAGE , MADDIPADU MANDAL
Mobile/Tel No. 7207955556
Other Details
Enclosures
1.Birth certificate issued by the Registrar of Births and Deaths or the Municipal Corporation or any other prescribed authority whosoever
has been empowered under the Registration of Birth and Deaths Act, 1969 to register the birth of a child born in India
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.

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Application Form https://portal2.passportindia.gov.in/AppOnlineProject/secure/Applican...

Place ONGOLE
Date 31/03/2024

2 of 2 3/31/2024, 4:47 PM