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    Thahira is applying for a fresh normal Indian passport. She provides her personal details including name, date of birth, place of birth, gender, marital status, citizenship, address, contact information, and family details. She affirms that the information provided is true and correct and that she will be penalized if any information is false. She acknowledges her allegiance to India and has not acquired any other citizenship.

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    Thahira is applying for a fresh normal Indian passport. She provides her personal details including name, date of birth, place of birth, gender, marital status, citizenship, address, contact information, and family details. She affirms that the information provided is true and correct and that she will be penalized if any information is false. She acknowledges her allegiance to India and has not acquired any other citizenship.

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    Thahira is applying for a fresh normal Indian passport. She provides her personal details including name, date of birth, place of birth, gender, marital status, citizenship, address, contact information, and family details. She affirms that the information provided is true and correct and that she will be penalized if any information is false. She acknowledges her allegiance to India and has not acquired any other citizenship.

    Copyright:

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

    View - Print Submitted Form PDF

    Uploaded by

    business service
    Thahira is applying for a fresh normal Indian passport. She provides her personal details including name, date of birth, place of birth, gender, marital status, citizenship, address, contact information, and family details. She affirms that the information provided is true and correct and that she will be penalized if any information is false. She acknowledges her allegiance to India and has not acquired any other citizenship.

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    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 22-1009142541  
     
    Applying For FRESH

    Type of Application NORMAL

    Type of Passport Booklet NORMAL


    Applicant Details
    Applicant's Name THAHIRA

    Date of Birth (DD/MM/YYYY) 01/01/1971

    Validity Required NA   

    Place of Birth (Village/Town/City) SHIRVA

    District UDUPI

    State/UT KARNATAKA

    Region/Country INDIA
    Signature/Left Hand Thumb Impression
    Gender FEMALE of Illiterate Applicant and Minors
    who
    Marital Status MARRIED cannot sign.
     
    Citizenship of India by BIRTH  
     
    Employment Type OTHERS

    Is either of your parent (in case of


    Y
    minor)/spouse, a government servant?

    Educational Qualification 7TH PASS OR LESS

    Are you eligible for Non-ECR category? Y

    Aadhaar Number 614284665166

    Family Details
    Father's Name H BAVA

    Mother's Name BI FATHIMA

    Spouse's Name MAIYADI


    Present Residential Address Details
    17-109 THOPANANGADI BHOOTABETTU SHIRVA POST,
    Address
    SHIRVA, UDUPI, KARNATAKA

    PIN 574116

    Police Station SHIRVA


    Mobile/Tel No. 9900899965

    E-mail ASHONLINESERVICE054@GMAIL.COM
    Emergency Contact Details
    Name and Address AHAD

    Mobile/Tel No. 7411132313


    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.Aadhaar Card/E-Aadhaar

    2.Aadhaar Card (Address Proof)


    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 SHIRVA Signature/Left Hand Thumb Impression of


    Applicant
    (If applicant is minor, either parent
    Date 11/08/2022 to sign)

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