PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-0017877820
Applying For REISSUE
If Re-issue, specify reason(s) VALIDITY EXPIRED WITHIN 3 YEARS/DUE TO EXPIRE.
Type of Application TATKAAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name MANNU SHARMA
Date of Birth (DD/MM/YYYY) 12/05/1989
Validity Required NA
Place of Birth (Village/Town/City) KUSHINAGAR
District KUSHI NAGAR
State/UT UTTAR PRADESH
Region/Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
Employment Type OTHERS
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
Visible Distinguishing Mark NAN
Aadhaar Number 697273989904
Family Details
Father's Name RAMASHANKAR SHARMA
Mother's Name TEEJA DEVI
Spouse's Name PINKI DEVI
Present Residential Address Details
Address RAVATPAR MAHUAWA KARKHANA, RAVATPAR, KUSHI NAGAR, UTTAR PRADESH
PIN 274402
Police Station TURKPATTI
Mobile/Tel No. 8874889035
E-mail [email protected]
Permanent Residential Address
Address RAVATPAR MAHUAWA KARKHANA, RAVATPAR, KUSHI NAGAR, UTTAR PRADESH
PIN 274402
Police Station TURKPATTI
Mobile/Tel No. 8874889035
Emergency Contact Details
Name and Address PANKAJ SHARMA
Mobile/Tel No. 9795508441
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number M9926666
Date of Issue 22/05/2015
Date of Expiry 21/05/2025
Place of Issue LUCKNOW
File Number LK1068737015415
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 KASIA
Date 22/10/2024