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The document is a passport application form for Divyanshu Kumar, applying for a fresh normal passport. It includes personal details such as his date of birth, address, and family information, along with a self-declaration affirming the accuracy of the provided information. The application is submitted to the Ministry of External Affairs, Government of India, and is dated May 19, 2025.

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18 views2 pages

Preview Form Ordinary Detail

The document is a passport application form for Divyanshu Kumar, applying for a fresh normal passport. It includes personal details such as his date of birth, address, and family information, along with a self-declaration affirming the accuracy of the provided information. The application is submitted to the Ministry of External Affairs, Government of India, and is dated May 19, 2025.

Uploaded by

divyanshuverma2902
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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5/19/25, 9:33 PM previewFormOrdinaryDetail

PASSPORT APPLICATION FORM


Ministry of External Affairs, Government of India

Service Required
Application Reference Number - 25-0051928059
Applying For - FRESH
Type of Application - NORMAL
Type of Passport Booklet - NORMAL

Applicant's Details
Applicant's Name - DIVYANSHU KUMAR
Date of Birth (DD/MM/YYYY) - 05/05/2006
Validity Required - NA
Place Of Birth (Village/Town/City) - BALLIA
District - BALLIA
State/UT - UTTAR PRADESH
Region/Country - INDIA
Gender - MALE
Marital Status - SINGLE
Citizenship of India by - BIRTH
Employment Type - GOVERNMENT
Is either of your parent (in case of - N
minor)/spouse, a government
servant?
Educational Qualification - 10TH PASS AND ABOVE
Are you eligible for Non-ECR - N
category
Aadhaar Number - 803720255095
PAN - MKMPK4900R
Voter ID - NCW2866689

Family Details
Father Name - SWAMINATH VERMA
Mother Name - MEENA DEVI

Present Residential Address Details


Address - 007, CIVIL LINES FATAHA, MIRZAPUR, MIRZAPUR, UTTAR PRADESH
Pin - 231001
Police Station - KOTWALI NAGAR
Mobile/Tel No - 9151741310
E-mail - DIVYANSHU123VERM@GMAIL.COM

Emergency Contact Details


Name and Address - MEENA DEVI, CIVIL LINES FATAHA MIRZAPUR UTTAR PRADESH
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5/19/25, 9:33 PM previewFormOrdinaryDetail

Mobile/Tel No - 7376907289
Email ID - DIVYANSHUVERMA2902@GMAIL.COM

Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport

Details of Previous/Current Diplomatic/Official Passport - N

Have you ever applied for passport, but not issued? - N

Other Details
Enclosures Details
1. Permanent Account Number Card issued by the Income-tax Department having the date of birth of the applicant
2. Bank/ Kisan/ Post Office Passbooks

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. 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 - MIRZAPUR

Date - 19/05/2025

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