1/25/25, 9:22 PM Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 25-0001314040
Applying For REISSUE
If Re-issue, specify reason(s) VALIDITY EXPIRED MORE THAN 3 YEARS AGO
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name NIKHIL TANAJI GORDE
Date of Birth (DD/MM/YYYY) 01/03/1984
Validity Required NA
Place of Birth (Village/Town/City) TALEGAON DABHADE PUNE MS
District PIMPRI CHINCHWAD
State/UT MAHARASHTRA
Region/Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
Employment Type PRIVATE
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? N
Aadhaar Number 949617353930
Family Details
Father's Name TANAJI NANABHAU GORDE
Mother's Name PORNIMA TANAJI GORDE
Spouse's Name NEHA NIKHIL GORDE
Present Residential Address Details
A/1 NISARG PHASE 2 KALEWADI PHATA KASPATE WASTI, WAKAD, PIMPRI
Address
CHINCHWAD, MAHARASHTRA
PIN 411057
Police Station WAKAD
Mobile/Tel No. 9689990007
E-mail [email protected]
Permanent Residential Address
A/1 NISARG PHASE 2 KALEWADI PHATA KASPATE WASTI, WAKAD, PIMPRI
Address
CHINCHWAD, MAHARASHTRA
PIN 411057
Police Station WAKAD
Mobile/Tel No. 9689990007
Emergency Contact Details
Name and Address NEHA NIKHIL GORDE
Mobile/Tel No. 7020631515
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number G7248584
Date of Issue 21/02/2008
Date of Expiry 20/02/2018
Place of Issue PUNE
File Number PNEP02752007
Other Details
Enclosures
1.PAN Card issued by the Income Tax Department
2.Aadhaar Card (Address Proof)

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1/25/25, 9:22 PM Application Form

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 WAKAD
Date 25/01/2025

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