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PASSPORT DATA FORM

The document is a passport application form for Vinay Jadaun, born on November 11, 2003, from Bhopal, Madhya Pradesh, India. He is applying for a fresh normal passport as a student with relevant personal and family details provided. The application includes a self-declaration affirming the authenticity of the information and enclosures submitted.

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vinayjadaun11112003
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3 views

PASSPORT DATA FORM

The document is a passport application form for Vinay Jadaun, born on November 11, 2003, from Bhopal, Madhya Pradesh, India. He is applying for a fresh normal passport as a student with relevant personal and family details provided. The application includes a self-declaration affirming the authenticity of the information and enclosures submitted.

Uploaded by

vinayjadaun11112003
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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15/10/2024, 17:37 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-0017540716
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name VINAY JADAUN
Date of Birth (DD/MM/YYYY) 11/11/2003
Validity Required NA
Place of Birth (Village/Town/City) BHOPAL
District BHOPAL
State/UT MADHYA PRADESH
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN CPWPJ6119Q
Employment Type STUDENT
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
Aadhaar Number 287694620853
Family Details
Father's Name MAHENDRA SINGH JADAUN
Mother's Name CHANDRAKANTA JADAUN
Present Residential Address Details
21,SHYAM NAGAR,BARKHEDA PATHANI, BHOPAL, BHOPAL, MADHYA
Address
PRADESH
PIN 462022
Police Station AWADHPURI
Mobile/Tel No. 8962671738 / 8871591738
E-mail [email protected]
Permanent Residential Address
21,SHYAM NAGAR,BARKHEDA PATHANI, BHOPAL, BHOPAL, MADHYA
Address
PRADESH
PIN 462022
Police Station AWADHPURI
Mobile/Tel No. 8962671738 / 8871591738
Emergency Contact Details
CHANDRAKANTA JADAUN, 21 SHYAM NAGAR BARKHEDA PATHANI
Name and Address
BHOPAL
Mobile/Tel No. 8871591738 / 9926311824
E-mail [email protected]
Other Details
Enclosures
1.PAN Card issued by the Income Tax Department
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.

https://portal1.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 1/2
15/10/2024, 17:37 Application Form
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 BHOPAL
Date 15/10/2024

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