PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-0015461644
Applying For REISSUE
If Re-issue, specify reason(s) VALIDITY EXPIRED WITHIN 3 YEARS/DUE TO EXPIRE.
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name BANDU LAXMAN JAMDADE
Date of Birth (DD/MM/YYYY) 05/06/1975
Validity Required NA
Place of Birth (Village/Town/City) BHOSE K TAL PANDHARPUR
District SOLAPUR RURAL
State/UT MAHARASHTRA
Region/Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN AMEPJ3476D
Employment Type SELF EMPLOYED
Is either of your parent (in case of minor)/spouse, a government
N
servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 559493810322
Family Details
Father's Name LAXMAN MADHAV JAMDADE
Mother's Name ANUSAYA LAXMAN JAMDADE
Spouse's Name UMA BANDU JAMDADE
Present Residential Address Details
AT POST BHOSE K TAL PANDHARPUR DIST SOLAPUR, BHOSE K, SOLAPUR RURAL,
Address
MAHARASHTRA
PIN 413315
Police Station KARKAMB
Mobile/Tel No. 9921939498
E-mail [email protected]
Permanent Residential Address
AT POST BHOSE K TAL PANDHARPUR DIST SOLAPUR, BHOSE K, SOLAPUR RURAL,
Address
MAHARASHTRA
PIN 413315
Police Station KARKAMB
Mobile/Tel No. 9921939498
Emergency Contact Details
Name and Address ASHIRAVAD BANDU JAMDADE AT POST BHOSE K TAL PANDHARPUR DIST SOLAPUR
Mobile/Tel No. 7840939498
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number L8941005
Date of Issue 25/04/2014
Date of Expiry 24/04/2024
Place of Issue PUNE
File Number PN0167615542214
Other Details
Enclosures
1.PAN Card issued by the Income Tax Department
2.Aadhaar Card (Address Proof)
3.Affidavit stating how and where the Passport got lost/ damaged as per Annexure F
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 BHOSE
Date 07/09/2024