12/28/24, 1:42 PM Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-0021541500
Applying For REISSUE
If Re-issue, specify reason(s) LOST PASSPORT
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name HARDEEP KAUR
Date of Birth (DD/MM/YYYY) 18/01/1994
Validity Required NA
Place of Birth (Village/Town/City) CHANDIGARH
District CHANDIGARH
State/UT CHANDIGARH
Region/Country INDIA
Gender FEMALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN JYLPK0855H
Employment Type SELF EMPLOYED
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
Aadhaar Number 252982710026
Family Details
Father's Name GURCHARAN SINGH
Mother's Name NEELAM SINGH
Present Residential Address Details
HOUSE NO 634 B HOUSING BOARD COLONY DHANAS, CHANDIGARH,
Address
CHANDIGARH, CHANDIGARH
PIN 160014
Police Station IT PARK
Mobile/Tel No. 9646643590
E-mail [email protected]
Permanent Residential Address
HOUSE NO 634 B HOUSING BOARD COLONY DHANAS, CHANDIGARH,
Address
CHANDIGARH, CHANDIGARH
PIN 160014
Police Station IT PARK
Mobile/Tel No. 9646643590
Emergency Contact Details
Name and Address RAJAT SONDHI
Mobile/Tel No. 7289059242
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number U5902201
Date of Issue 13/12/2019
Date of Expiry 12/12/2029
Place of Issue CHANDIGARH
Other Details
Enclosures
1.PAN Card issued by the Income Tax Department
2.Aadhaar Card (Address Proof)
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12/28/24, 1:42 PM Application Form
3.Affidavit stating how and where the Passport got lost/ damaged as per Annexure F
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 CHANDIGARH
Date 28/12/2024

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