Scribd
Upload
8 views

SANIYA KHATUN Submitted Form

Uploaded by

akkashhussain25
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
8 views

SANIYA KHATUN Submitted Form

Uploaded by

akkashhussain25
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
You are on page 1/ 2

12/10/24, 9:39 AM View/Print Submitted Form

File Number (For Office Use Only)

GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS

PASSPORT APPLICATION FORM

Please read the Passport Instruction Booklet carefully before filling the form. Fill this form in CAPITAL LETTERS using
blue/black ink ball point pen only. Furnishing of incorrect information/ suppression of information would lead to rejection of the
application and would attract penal provisions as prescribed under the Passports Act, 1967. Please produce your original
documents at the time of submission of the form.

Service Required
Application Reference Number 24-1014874549

Applying For FRESH

Type of Application NORMAL

Type of Passport Booklet NORMAL


Applicant Details
Applicant's Name SANIYA KHATUN

Date of Birth (DD/MM/YYYY) 07/06/2010

Validity Required NA

Place of Birth (Village/Town/City) WEST MEDINIPUR

District WEST MEDINIPUR

State/UT WEST BENGAL

Region/Country INDIA
Signature/Left Hand Thumb Impression
Gender FEMALE of Illiterate Applicant and Minors who
Marital Status SINGLE cannot sign.

Citizenship of India by BIRTH

Employment Type STUDENT

Is either of your parent (in case of


N
minor)/spouse, a government servant?

Educational Qualification 7TH PASS OR LESS

Are you eligible for Non-ECR category? N

Aadhaar Number 528098702023

Family Details
Father's Name MIR SANOWAR

Mother's Name ABSANA BIBI


Present Residential Address Details
BHIKUBAR,PASCHIM MEDNIPUR,, BHIKUBAR, WEST
Address
MEDINIPUR, WEST BENGAL

PIN 721426

Police Station DANTAN

Mobile/Tel No. 7872550830

https://portal2.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=24-1014874549 1/2
12/10/24, 9:39 AM View/Print Submitted Form

E-mail [email protected]
Emergency Contact Details
Name and Address MIR SANOWAR

Mobile/Tel No. 8910515129


Other Details
Fee Details (Not to be filled by applicants submitting the application at Passport Seva Kendra/Passport Office)
Fee amount in (Rs)

If paid by Demand Draft(DD), provide the following details

DD Issue Date (dd/mm/yyyy)

DD Expiry Date (dd/mm/yyyy)

Bank Name

Branch
Enclosures
1.Birth certificate issued by the Registrar of Births and Deaths or the Municipal Corporation or any other prescribed authority
whosoever has been empowered under the Registration of Birth and Deaths Act, 1969 to register the birth of a child born in India

2.Aadhaar Card (Address Proof)

3.A declaration affirming the particulars furnished in the application about the minor as per Annexure C
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 KOLKATA Signature/Left Hand Thumb Impression of


Applicant (If applicant is minor, either parent
Date 07/12/2024 to sign)

https://portal2.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=24-1014874549 2/2

You might also like