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17 views

Application Form

Uploaded by

namasivay.dinesh
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 24-0016424380
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name RAJU KUMAR JATAN
Date of Birth (DD/MM/YYYY) 09/02/1999
Validity Required NA
Place of Birth (Village/Town/City) BHELWA
District NAWADA
State/UT BIHAR
Region/Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN GJLPK5992R
Voter Id UAO3218633
Employment Type PRIVATE
Is either of your parent (in case of minor)/spouse, a government
N
servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark A MOLE ON THE RIGHT SHOULDER BACK SI
Aadhaar Number 620590319986
Family Details
Father's Name JATAN RAJWANSHI GOPI
Mother's Name KALO DEVI JATAN
Spouse's Name JYOTI KUMARI RAJU KUMAR
Present Residential Address Details
Address GRAM-BHELWA,POST HISUA,, BHELWA, NAWADA, BIHAR
PIN 805103
Police Station HISUA
Mobile/Tel No. 9845577760
E-mail [email protected]
Permanent Residential Address
Address GRAM-BHELWA,POST HISUA,, BHELWA, NAWADA, BIHAR
PIN 805103
Police Station HISUA
Mobile/Tel No. 9845577760
Emergency Contact Details
Name and Address JYOTI KUMARI
Mobile/Tel No. 7091367530
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 BIHAR
Date 24/09/2024

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