PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-0008315386
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 BHAGWAN SINGH CHAUHAN
Date of Birth (DD/MM/YYYY) 22/01/1994
Validity Required NA
Place of Birth (Village/Town/City) KHATIMA
District UDHAM SINGH NAGAR
State/UT UTTARAKHAND
Region/Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN IWXPS2826F
Voter Id ISPO272930
Employment Type PRIVATE
Is either of your parent (in case of minor)/spouse, a government servant? Y
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark MOLE ON LEFT LOWER LIP
Aadhaar Number 559002600284
Family Details
Father's Name GOVIND SINGH CHAUHAN
Mother's Name REKHA CHAUHAN
Spouse's Name SHILPA CHAUHAN
Present Residential Address Details
Address H-NO.284,KHETAL SANDA MUSTAJAR,CHAKARPUR,KHATIMA, KHETAL SANDA MUSTAJAR, KHATIMA, UDHAM SINGH NAGAR, UTTARAKHAND
PIN 262308
Police Station KHATIMA
Mobile/Tel No. 7906269212
E-mail [email protected]
Permanent Residential Address
Address H-NO.284,KHETAL SANDA MUSTAJAR,CHAKARPUR,KHATIMA, KHETAL SANDA MUSTAJAR, KHATIMA, UDHAM SINGH NAGAR, UTTARAKHAND
PIN 262308
Police Station KHATIMA
Mobile/Tel No. 7906269212
Emergency Contact Details
Name and Address LAXMAN SINGH CHAUHAN / KHETAL SANDA MUSTAJAR, KHATIMA , U.S.NAGAR
Mobile/Tel No. 9870728279
E-mail [email protected]
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number L8730403
Date of Issue 16/05/2014
Date of Expiry 22/05/2024
Place of Issue DEHRADUN
File Number DD1067567241614
Other Details
Enclosures
1.Election Photo Identity Card (EPIC) issued by the Election Commission of India
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 an
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 KHATIMA
Date 12/05/2024
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