Scribd Logo
Upload

Welcome to Scribd!

  • 98 views

    Passport Application Form Government of INDIA, Ministry of External Affairs

    Uploaded by

    Vibhor Mittal
    Vibhor Mittal is applying for an Indian passport reissue as his previous passport expired more than 3 years ago. He is providing details such as his name, date of birth, parents' names, address, and contact information. He is declaring his allegiance to India and affirming that the information provided is accurate to the best of his knowledge.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Passport Application Form Government of INDIA, Ministry of External Affairs

    Uploaded by

    Vibhor Mittal
    98 views2 pages
    Vibhor Mittal is applying for an Indian passport reissue as his previous passport expired more than 3 years ago. He is providing details such as his name, date of birth, parents' names, address, and contact information. He is declaring his allegiance to India and affirming that the information provided is accurate to the best of his knowledge.

    Original Description:

    b

    Original Title

    Application Form

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Vibhor Mittal is applying for an Indian passport reissue as his previous passport expired more than 3 years ago. He is providing details such as his name, date of birth, parents' names, address, and contact information. He is declaring his allegiance to India and affirming that the information provided is accurate to the best of his knowledge.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    98 views2 pages

    Passport Application Form Government of INDIA, Ministry of External Affairs

    Uploaded by

    Vibhor Mittal
    Vibhor Mittal is applying for an Indian passport reissue as his previous passport expired more than 3 years ago. He is providing details such as his name, date of birth, parents' names, address, and contact information. He is declaring his allegiance to India and affirming that the information provided is accurate to the best of his knowledge.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    7/19/2017 Application Form

    PASSPORT APPLICATION FORM

    Government of INDIA, Ministry of External Affairs

    Service Required
    Application Reference Number 17-0010427828
    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 VIBHOR MITTAL
    Date of Birth (DD/MM/YYYY) 22/02/1996
    Validity Required 10 Years
    Place of Birth (Village/Town/City) SHAMLI
    District MUZAFFARNAGAR
    State/UT UTTAR PRADESH
    Country INDIA
    Gender MALE
    Marital Status SINGLE
    Citizenship of India by BIRTH
    PAN DEVPM3900P
    Employment Type STUDENT
    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? N
    Aadhaar Number 415806443922
    Family Details
    Father's Name SATISH KUMAR MITTAL
    Mother's Name BABITA MITTAL
    Present Residential Address Details
    Residing Since(MM/YYYY) 07/2004
    C-12,MAYUR NAGAR, LODHA, KOTWALI BANSWARA, BANSWARA,
    Address
    RAJASTHAN
    PIN 327001
    Mobile/Tel No. 8852883156 / 8114468929
    E-mail VIBHORMITTAL222@GMAIL.COM
    First Reference Name And Address RK GAGRANI,C-13,MAYUR NAGAR,LODHA BANSWARA-327001
    Mobile/Tel No. 9414005108
    Second Reference Name And Address BC GUPTA,B-3,MAYUR NAGAR,LODHA,BANSWARA-327001
    Mobile/Tel No. 9414005103
    Emergency Contact Details
    SATISH KUMAR MITTAL,C-12,MAYUR NAGAR,LODHA,BANSWARA-
    Name and Address
    327001,RAJASTHAN
    Mobile/Tel No. 9414103989 / 02962304207
    E-mail SKMITTAL@LNJBHILWARA.COM
    Previous Passport/ Application Details
    Details of latest held/existing/lost/damaged Ordinary Passport
    Passport Number A9082130
    Date of Issue 01/11/2000
    Date of Expiry 31/10/2005
    Place of Issue JALANDHAR
    Other Details
    Self Declaration
    I owe allegiance to the sovereignty, unity and 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 and I affirm that the information given by me in this

    https://portal1.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 1/2
    7/19/2017 Application Form

    form and the enclosures is true and I am solely responsible for its accuracy, and 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.
    Place BANSWARA
    Date 19/07/2017

    https://portal1.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 2/2

    You might also like