Scribd
Upload
2 views

View_Print Submitted Form

The document is a passport application form submitted to the Government of India for a fresh normal passport for a minor named Aditri, born on December 5, 2020, in Nanauta, Saharanpur, Uttar Pradesh. The application includes personal details, family information, and required enclosures such as a birth certificate and Aadhaar card. The applicant affirms the accuracy of the information provided and acknowledges the legal implications of submitting false information.

Uploaded by

nsdl00012
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
2 views

View_Print Submitted Form

The document is a passport application form submitted to the Government of India for a fresh normal passport for a minor named Aditri, born on December 5, 2020, in Nanauta, Saharanpur, Uttar Pradesh. The application includes personal details, family information, and required enclosures such as a birth certificate and Aadhaar card. The applicant affirms the accuracy of the information provided and acknowledges the legal implications of submitting false information.

Uploaded by

nsdl00012
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

4/3/25, 4:29 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 25-0005017450

Applying For FRESH

Type of Application NORMAL

Type of Passport Booklet NORMAL


Applicant Details
Applicant's Name ADITRI

Date of Birth (DD/MM/YYYY) 05/12/2020

Validity Required NA

Place of Birth (Village/Town/City) NANAUTA

District SAHARANPUR

State/UT UTTAR PRADESH

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 BETWEEN 8TH AND 9TH STANDARD

Are you eligible for Non-ECR category? Y

Aadhaar Number 971603743667

Family Details
Father's Name DR NARESH CHAND SHARMA

Mother's Name ALKA SHARMA

Father/Legal guardian's File/Passport Number C9124817

Mother/Legal guardian's File/Passport Number Y4902095


Present Residential Address Details
PRAKASH KUNJ VIHAR COLONY, MOHALLA
Address SHEKHJADGAN, NANAUTA, SAHARANPUR, UTTAR
PRADESH

https://portal1.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=25-0005017450 1/2
4/3/25, 4:29 AM View/Print Submitted Form

PIN 247452

Police Station NANUTA

Mobile/Tel No. 9412849709

E-mail [email protected]
Emergency Contact Details
Name and Address DR NARESH CHAND SHARMA

Mobile/Tel No. 9412849709


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 authority, empowered
under the Registration of Births and Deaths Act, 1969 (18 of 1969)

2.Aadhaar Card (Address Proof)

3.A declaration affirming the particulars furnished in the application about the minor as per Annexure C

4.A declaration affirming the particulars furnished in the application about the minor as per Annexure D

5.A declaration affirming the particulars furnished in the application about the minor as per Annexure I
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 NANAUTA Signature/Left Hand Thumb Impression of


Applicant (If applicant is minor, either parent
Date 03/04/2025 to sign)

https://portal1.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=25-0005017450 2/2

You might also like