3/12/24, 10:01 PM Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-1003438011
Applying For FRESH
Type of Application TATKAAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name HARSHITH VISHNU
Date of Birth (DD/MM/YYYY) 13/05/2016
Validity Required NA
Place of Birth (Village/Town/City) KOLLAM
District KOLLAM CITY
State/UT KERALA
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)/spouse, a
N
government servant?
Educational Qualification 7TH PASS OR LESS
Are you eligible for Non-ECR category? Y
Aadhaar Number 926447786289
Family Details
Father's Name VISHNU HARSHAN
Mother's Name SRUTHI BINDHU SREEKUMAR
Father/Legal guardian's File/Passport Number X4678433
Nationality INDIAN
Mother/Legal guardian's File/Passport Number S1899546
Nationality INDIAN
Present Residential Address Details
SRUTHI BHAVANAM, PEROOR,, THATTARKONAM PO, KOLLAM CITY,
Address
KERALA
PIN 691005
Police Station KILIKOLLOOR
Mobile/Tel No. 9747262310
E-mail [email protected]
Permanent Residential Address
SRUTHI BHAVANAM, PEROOR,, THATTARKONAM PO, KOLLAM CITY,
Address
KERALA
PIN 691005
Police Station KILIKOLLOOR
Mobile/Tel No. 9747262310
Emergency Contact Details
SREEKUMAR, SRUTHI BHAVANAM, PEROOR, THATTARKONAM PO,
Name and Address
KOLLAM 691005
Mobile/Tel No. 9747262310
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

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3/12/24, 10:01 PM Application Form
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 KOLLAM
Date 12/03/2024

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