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Application Form

The GD night and the most beautiful shot of the day of your you and your family a year ahead you are not letting me know if you are free to contact me if you

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VINAYA DHAVALAGI
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14 views

Application Form

The GD night and the most beautiful shot of the day of your you and your family a year ahead you are not letting me know if you are free to contact me if you

Uploaded by

VINAYA DHAVALAGI
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 22-1014021739
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name VINAYA DHAVALAGI
Date of Birth (DD/MM/YYYY) 23/09/1995
Validity Required NA
Place of Birth (Village/Town/City) RANIBENNUR
District HAVERI
State/UT KARNATAKA
Region/Country INDIA
Gender FEMALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN CASPD6524Q
Employment Type SELF EMPLOYED
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 393134301516
Family Details
Father's Name MANOHAR
Mother's Name MAHALAKSHMI
Spouse's Name PRASHANTAGOUDA
Present Residential Address Details
C/O:MANOHAR,799 HUGGIYAVAR ONI ANTARAVALLI ROAD, RANIBENNUR,
Address
HAVERI, KARNATAKA
PIN 581115
Police Station RANEBENNUR TOWN
Mobile/Tel No. 6364362987
E-mail [email protected]
Permanent Residential Address
C/O:MANOHAR,799 HUGGIYAVAR ONI ANTARAVALLI ROAD, RANIBENNUR,
Address
HAVERI, KARNATAKA
PIN 581115
Police Station RANEBENNUR TOWN
Mobile/Tel No. 6364362987
Emergency Contact Details
Name and Address PRASHANTAGOUDA
Mobile/Tel No. 9743020613
E-mail [email protected]
Other Details
Enclosures
1.Transfer/School leaving/Matriculation Certificate issued by the school last attended/recognized educational board
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 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 RANIBENNUR
Date 29/11/2022
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