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Application Form

hgycutgh

Uploaded by

Murtuza Ali
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-1010678929
Applying For REISSUE
If Re-issue, specify reason(s) CHANGE IN EXISTING PERSONAL PARTICULARS
If change in existing personal particulars, specify SPOUSE NAME , ADDRESS
Type of Application TATKAAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name SHABNAM ABDUL GAFFAR
Date of Birth (DD/MM/YYYY) 19/04/1990
Validity Required NA
Place of Birth (Village/Town/City) MUMBAI
District MUMBAI
State/UT MAHARASHTRA
Region/Country INDIA
Gender FEMALE
Marital Status MARRIED
Citizenship of India by BIRTH
Employment Type NOT EMPLOYED
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 451782947049
Family Details
Father's Name ABDUL GAFFAR PATHAN
Mother's Name NASEEM
Spouse's Name MD SALMAN
Present Residential Address Details
11-1624, 2ND FLOOR GANDHI STATUE CHILKALGUDA, HYDERABAD, HYDERABAD,
Address
TELANGANA
PIN 500061
Police Station CHILKALGUDA
Mobile/Tel No. 8106917084
E-mail [email protected]
Permanent Residential Address
11-1624, 2ND FLOOR GANDHI STATUE CHILKALGUDA, HYDERABAD, HYDERABAD,
Address
TELANGANA
PIN 500061
Police Station CHILKALGUDA
Mobile/Tel No. 8106917084
Emergency Contact Details
Name and Address MD SALMAN 11-1624, 2ND FLOOR GANDHI STATUE
Mobile/Tel No. 8106917084
E-mail [email protected]
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number Y8578035
Date of Issue 20/09/2023
Date of Expiry 19/09/2033
Place of Issue MUMBAI
Details of Previous/Current Diplomatic/Official Passport
Passport Number Y8578035
Date of Issue 20/09/2023
Date of Expiry 19/09/2033
Place of Issue MUMBAI
Other Details
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.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 HYDERABAD
Date 27/08/2024

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