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File Number (For Office Use Only)

Ministry of External Affairs, Government of India

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 - 25-1051987961 Please paste your
Number unsigned recent
Applying For - FRESH color photograph
of size 4.5cm *
Type of Application - NORMAL 3.5cm.
Type of Passport - NORMAL
Booklet

Applicant Details
Applicant's Name - BASHIR SAYYEDLAL SAYYED
Date of Birth - 05/08/1969
(DD/MM/YYYY) Signature/Left Hand Thumb
Validity Required - NA Impression of Illiterate Applicant and
Minors who cannot sign.
Place Of Birth - HYDERABAD
(Village/Town/City)
District - HYDERABAD
State/UT - TELANGANA
Region/Country - INDIA
Gender - MALE
Marital Status - SINGLE
Citizenship of India by - BIRTH
Employment Type - OTHERS
Is either of your parent - N
(in case of
minor)/spouse, a
government servant?
Educational - 7TH PASS OR LESS
Qualification
Are you eligible for - Y
Non-ECR category
Aadhaar Number - 939499900851

Family Details
Father Name - SAYYEDLAL
Mother Name - ZAITUN BEE

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5/19/25, 12:09 PM ViewPrintApplicationReceipt

Present Residential Address Details:

Address - 17-3-325/12/1/A, MURTUZA NAGAR, YAKUTPURA, HYDERABAD,
HYDERABAD, TELANGANA
Pin - 500023
Police Station - REINBAZAR
Mobile/Tel No - 9922786721
Email - R6655973@GMAIL.COM

Permanent Residential Address Details

Address - 17-3-325/12/1/A, MURTUZA NAGAR, YAKUTPURA, HYDERABAD,
HYDERABAD, TELANGANA
Pin - 500023
Police Station - REINBAZAR
Mobile/Tel No - 9922786721

EmergencyContactDetails:
Name and Address - SAYYEDLAL
Mobile/Tel No. - 9922786721

Previous Passport

Other Details
Fee Details (Not to be filled by applicants submitting the application at Passport Seva
Kendra/Passport Office)
Fee amount in (Rs) -
If paid by Demand Draft(DD), provide the following details

DD Issue Date (dd/mm/yyyy) -

DD Expiry Date (dd/mm/yyyy) -
Bank Name -
Branch -
Enclosures:
1. Aadhaar Card (Address Proof)2. Permanent Account Number Card issued by the Income-tax Department having the
date of birth of the applicant

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.

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5/19/25, 12:09 PM ViewPrintApplicationReceipt

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 - HYDERABAD
Signature/Left Hand Thumb Impression
of Applicant (If applicant is minor, either
Date - 19/05/2025
parent to sign)

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