22, MIR EMAD STREET (CORNER OF 9TH ALLEY), DR.

BEHESHTI AVENUE, TEHRAN, IRAN

00-98-21-88755103 https://www.indianembassytehran.gov.in/
PASSPORT PREVIEW

भारत गणराज्य REPUBLIC OF INDIA

Paste your unsigned recent color photograph of Size 2"X2" and Signature/Left Hand Thumb Impression in the box provided

टाइप/Type राष्ट्र कोड/CountryCode पासपोटर् नं./PassportNo.

P IND
उपनाम/Surname
Paste your unsigned
SADAT
recent color photograph
िदया गया नाम/Given Name(s)
Size 2"X2" and
NAZANIN TAHOORA
Signature/Left Hand
राष्ट्रीयता/Nationality िलं ग/Sex जन्मितिथ/Date of Birth
Thumb Impression in
INDIAN F 29/10/2024
the box provided below
जन्म स्थान/Place of Birth

Generated on: Thursday, December 19, 2024 2:36:42 AM

MASHHAD, IRAN

जारी करने का स्थान/Place of Issue

जारी करने की ितिथ/Date of Issue समािप्त की ितिथ/Date of Expiry

िपता/कानूनी अिभभावक का नाम/Name of Father/Legal Guardian

SYED ALI REZA

माता का नाम/Name of Mother

NARGES BAGHERZADEH MESHKI BAF

पित या पत्नी का नाम/Name of Spouse

पता/Address

SHAYKH SADUGHE 19 PLAQUE 81

POSHTE DARMANGAH SILU GANDOM

9146878547, MASHHAD IRAN

पुराने पासपोटर् का नं. और इसके जारी होने की ितिथ एवं स्थान/Old Passport No with Date and Place of Issue

फ़ाइल नं./File No.

Service Required
Application Reference Number (ARN) 24-2005890100
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet 36 Pages
Applicant Details
Applicant's Name NAZANIN TAHOORA SADAT
Applicant's Alias Name N
Applicant's Change In Name N
:
 Date of Birth (DD/MM/YYYY) 29/10/2024
Validity Required NA
Place of Birth (Village/Town/City) MASHHAD
Country IRAN
Gender FEMALE
Marital Status SINGLE
Citizenship of India by DESCENT
Employment Type NOT EMPLOYED
Is either of your parent (in case of minor)/spouse, a government
servant?
N
Educational Qualification 7TH PASS OR LESS
Are you eligible for Non-ECR category? N
Visible Distinguishing Mark NONE
Family Details(as in passport)
Father's Name SYED ALI REZA
Mother's Name NARGES BAGHERZADEH MESHKI BAF
Father's Passport No Z5099057
Father's Nationality INDIAN
Mother's Passport No Y59357199
Mothers's Nationality IRANIAN
Passport Printable Address Details
SHAYKH SADUGHE 19 PLAQUE 81 POSHTE
To be printed on passport DARMANGAH SILU GANDOM 9146878547, MASHHAD
IRAN
Mobile/Telephone Number 989158295493
E-mail ALIREZANAQVI72@GMAIL.COM
Other Address Details
Address GAURI KHALSA POST SUBHAN KHERA TEHSIL
SANDILA, HARDOI PIN:241305, UTTAR PRADESH,
INDIA
Mobile/Telephone Number 919956836115
Emergency Contact Details
Name and Address
RIYAZ HAIDER , GAURI KHALSA POST SHUBAN
KHERA TEHSIL SANDILA DISTRICT HARDOI U.P
Mobile/Telephone Number 9956836115
Previous Passport
Have you ever applied for passport, but not issued? N
Details of Previous/Current Diplomatic/Official Passport N
Other Details
1) Provide the following details if there are any criminal proceedings pending against the applicant.
1.1) Are any proceedings in respect of an offence alleged to have been committed by you pending before a criminal court in India? N
1.2) Has any warrant or summons for your appearance been issued and pending before a court under any law for the time being in force? N
1.3) Has a warrant for your arrest been issued by a court under any law for the time being in force? N
1.4) Has an order prohibiting your departure from India been made by any court? N
2) Provide the following details if the applicant has been convicted by a court in India.
2.1) Have you at any time during the period of five years immediately preceding the date of this application been convicted by a court in India for
any offence involving moral turpitude and sentenced in respect thereof to imprisonment for not less than two years?
N
3) Provide the following details if the applicant has been refused/denied passport.
3.1) Have you ever been refused/denied passport? N
3.2) Has your passport ever been impounded? N
3.3) Has your passport ever been revoked? N
4) Provide the following details if applicant has applied for or been granted foreign citizenship.
4.1) Have you ever applied for or been granted citizenship by any other country? N
4.2) Have you ever held the passport of any other country at any time? N
4.3) Have you ever surrendered your Indian passport? N
:
 4.4) Have you ever applied for renunciation of Indian citizenship? N
5) Provide the following details if applicant has returned to India on Emergency Certificate.
5.1) Have you ever returned to India on Emergency Certificate (EC)? N
5.2) Have you ever been deported from any country? N
5.3) Have you ever been repatriated from any country back to India? N
Self Declaration
I declare:

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.
I understand:

That Ministry of External Affairs (MEA) (or its implementation partner agencies/stakeholders/third parties) may undertake required checks to confirm the
accuracy and authenticity of evidence I have provided and documents I have submitted with this application.
That the information I provide, including biometric data (if any), will be treated in confidence, but it may be disclosed to other government departments,
agencies, local authorities, foreign governments, and other implementation partner agencies/stakeholders/third parties to enable MEA or those bodies to
perform their duties.
That providing biometric information, if collected as part of an application, is confirmation of my consent to getting the biometric information checked to
verify identity.
That the Passport and related services applications may be handled by the Indian Embassies/Consulates/ Passport Office/other offices including outside of
the country in which I have applied and that this may involve the transfer of my application and supporting documents to and from the respective offices.
That my details may, in certain circumstances, be passed to Police, Intelligence and other Fraud Detection & Prevention agencies. I also understand that
such agencies may provide related information about me to MEA.

Place TEHRAN Signature/Left Hand Thumb Impression of Applicant

Date 19/12/2024 (If applicant is minor, either parent to sign)
: