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The document is a passport application form filled out by Farzana Ahmed Parkar. It contains her personal details like name, date of birth, address, as well as family details. It also includes details of her previous passport and enclosures submitted with the application.

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zaiddparkar1
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33 views3 pages

View - Print Submitted Form Mom 24

The document is a passport application form filled out by Farzana Ahmed Parkar. It contains her personal details like name, date of birth, address, as well as family details. It also includes details of her previous passport and enclosures submitted with the application.

Uploaded by

zaiddparkar1
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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12/11/23, 9:15 AM View/Print Submitted Form

File Number (For Office Use Only)

GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS

PASSPORT APPLICATION FORM

Please read the Passport Instruction Booklet carefully before filling the form. Fill this form in CAPITAL LETTERS using
blue/black ink ball point pen only. Furnishing of incorrect information/ suppression of information would lead to rejection of the
application and would attract penal provisions as prescribed under the Passports Act, 1967. Please produce your original
documents at the time of submission of the form.

Service Required
Application Reference Number 23-0021769766

Applying For REISSUE

VALIDITY EXPIRED MORE THAN 3


If Re-issue, specify reason(s)
YEARS AGO

Type of Application NORMAL

Type of Passport Booklet NORMAL


Applicant Details
Applicant's Name FARZANA AHMED PARKAR

Date of Birth (DD/MM/YYYY) 25/08/1973

Validity Required NA

Place of Birth (Village/Town/City) MUMBAI

District MUMBAI

Region/Country INDIA Signature/Left Hand Thumb Impression


of Illiterate Applicant and Minors who
Gender FEMALE cannot sign.
Marital Status MARRIED

Citizenship of India by BIRTH

PAN AYFPP7304K

Employment Type NOT EMPLOYED

Is either of your parent (in case of


Y
minor)/spouse, a government servant?

Educational Qualification 10TH PASS AND ABOVE

Are you eligible for Non-ECR category? Y

Aadhaar Number 564569735431

Family Details
Father's Name ALI MUHAMMED ISMAIL JAGBANI

Mother's Name BANUBAI ALI MUHAMMED JAGBANI

Spouse's Name AHMED ABBAS PARKAR


Present Residential Address Details
https://portal1.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=23-0021769766 1/3
12/11/23, 9:15 AM View/Print Submitted Form

CGS COLONY T/B/S BLOCKNO.23 ROOM NO.258 LBS


Address
MARG, MUMBAI, MUMBAI, MAHARASHTRA

PIN 400086

Police Station BYCULLA

Mobile/Tel No. 9768844960 / 9619227549

E-mail FARZANAPARKAR78@GMAIL.COM
Permanent Residential Address
CGS COLONY T/B/S BLOCKNO.23 ROOM NO.258 LBS
Address
MARG, MUMBAI, MUMBAI, MAHARASHTRA

PIN 400086

Police Station BYCULLA

Mobile/Tel No. 9768844960 / 9619227549


Emergency Contact Details
BANUBAI ALI MUHAMMED AASHIRWAD PREM BLDG,
Name and Address
GANGA COMPLEX MIRA ROAD WEST

Mobile/Tel No. 8286929505 / 9619227549

E-mail PARKARAHMED7024@GMAIL.COM
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number A1781

Date of Issue 15/10/1992

Date of Expiry 14/10/2002

Place of Issue BOMBAY


Details of Previous/Current Diplomatic/Official Passport
Passport Number A1781

Date of Issue 15/10/1992

Date of Expiry 14/10/2002

Place of Issue BOMBAY


Other Details
Payment Details
Mode of Payment UPI

Date 04/12/2023

Receipt/Reference No. CPADHUDAH9

Amount Received (Rs.) 1500.00 (ONE THOUSAND FIVE HUNDRED ONLY)


Enclosures
1.PAN Card issued by the Income Tax Department

2.Aadhaar Card (Address Proof)

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
https://portal1.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=23-0021769766 2/3
12/11/23, 9:15 AM View/Print Submitted Form

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 MUMBAI Signature/Left Hand Thumb Impression of


Applicant (If applicant is minor, either parent
Date 04/12/2023 to sign)

https://portal1.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=23-0021769766 3/3

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