29/06/2024, 13:37 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-0011392290
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name MUSHIR AHMED
Date of Birth (DD/MM/YYYY) 13/08/2001
Validity Required NA
Place of Birth (Village/Town/City) BHADOHI
District BHADOHI
State/UT UTTAR PRADESH
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN EFFPA8353Q
Employment Type OTHERS
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 532842520375
Family Details
Father's Name MASHOOK AHMAD
Mother's Name DARAKSHA BEGUM
Present Residential Address Details
CHAKSHAHAB SAGARRAIPUR, SANT RAVIDAS NAGAR, BHADOHI, UTTAR
Address
PRADESH
PIN 221310
Police Station GOPIGANJ
Mobile/Tel No. 9935093507
E-mail MUSHIRAHMAD2000@GMAIL.COM
Permanent Residential Address
CHAKSHAHAB SAGARRAIPUR, SANT RAVIDAS NAGAR, BHADOHI, UTTAR
Address
PRADESH
PIN 221310
Police Station GOPIGANJ
Mobile/Tel No. 9935093507
Emergency Contact Details
Name and Address MASHOOK AHMAD
Mobile/Tel No. 9935203711
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 penalized
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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 BHADOHI
Date 29/06/2024

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