9/23/22, 6:45 PM Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 22-1011057915
Applying For REISSUE
If Re-issue, specify reason(s) CHANGE IN EXISTING PERSONAL PARTICULARS
If change in existing personal particulars, specify SURNAME , ADDRESS
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name ZAMREN JAFARULLAH
Date of Birth (DD/MM/YYYY) 16/10/1998
Validity Required NA
Place of Birth (Village/Town/City) RANIPET
District VELLORE
State/UT TAMIL NADU
Region/Country INDIA
Gender FEMALE
Marital Status SINGLE
Citizenship of India by BIRTH
Employment Type OTHERS
Is either of your parent (in case of minor)/spouse, a government
N
servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 951591612360
Family Details
Father's Name JAFARULLAH KHAN
Mother's Name KULSIYA BEEVI
Present Residential Address Details
H-35,NEW TNHB,SIPCOT, RANIPET,VELLORE, RANIPET, TAMIL
Address
NADU
PIN 632403
Police Station RANIPET
Mobile/Tel No. 9944487724
E-mail ZAMREN1610@GMAIL.COM
Permanent Residential Address
H-35,NEW TNHB,SIPCOT, RANIPET,VELLORE, RANIPET, TAMIL
Address
NADU
PIN 632403
Police Station RANIPET
Mobile/Tel No. 9944487724
Emergency Contact Details
ZAMREN JAFARULLAH,H-35,NEW TNHB,SIPCOT
Name and Address
,RANIPET,VELLORE-632403
Mobile/Tel No. 9944487724
E-mail ZAMREN1610@GMAIL.COM
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number V1299247
Date of Issue 09/07/2021
Date of Expiry 08/07/2031
Place of Issue CHENNAI
File Number MA51C5019464321
Other Details

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9/23/22, 6:45 PM Application Form

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 RANIPET
Date 23/09/2022

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