9/10/24, 4:01 PM Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-0015642868
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name TAHEJEEBUL HASAN
Date of Birth (DD/MM/YYYY) 29/07/2005
Validity Required NA
Place of Birth (Village/Town/City) DELHI
District NORTH EAST DELHI
State/UT DELHI
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN BTXPH7234Q
Employment Type SELF EMPLOYED
Is either of your parent (in case of minor)/spouse,
N
a government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 813388664010
Family Details
Father's Name ISRAT ALI
Mother's Name BUSRA
Present Residential Address Details
HOUSE NO 315 A BLOCK STREET NO 8,, KHAJOORI KHAS, NORTH EAST
Address
DELHI, DELHI
PIN 110094
Police Station KHAJOORI KHAS
Mobile/Tel No. 9310739377
E-mail [email protected]
Permanent Residential Address
HOUSE NO 315 A BLOCK STREET NO 8,, KHAJOORI KHAS, NORTH EAST
Address
DELHI, DELHI
PIN 110094
Police Station KHAJOORI KHAS
Mobile/Tel No. 9310739377
Emergency Contact Details
ISRAT ALI HOUSE NO -315,GALI NO-08 ,BLOCK -A, SHRI RAM COLONY
Name and Address
KRAWAL NAGAR
Mobile/Tel No. 7503773137
E-mail [email protected]
Other Details
Enclosures
1.PAN Card issued by the Income Tax Department
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.

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9/10/24, 4:01 PM Application Form
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 DELHI
Date 10/09/2024
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