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    Bapi Form

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    alaminsekh417

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    © All Rights Reserved
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    Bapi Form

    Uploaded by

    alaminsekh417
    7 views2 pages

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    © © All Rights Reserved

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    Copyright:

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

    Bapi Form

    Uploaded by

    alaminsekh417

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    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 24-1001946801

    Applying For FRESH

    Type of Application TATKAAL

    Type of Passport Booklet NORMAL


    Applicant Details
    Applicant's Name AJIJUL MAJHI

    Date of Birth (DD/MM/YYYY) 15/12/1997

    Validity Required NA

    Place of Birth (Village/Town/City) CHARAVIDYA

    District BARUIPUR

    State/UT WEST BENGAL

    Region/Country INDIA
    Signature/Left Hand Thumb Impression
    Gender MALE of Illiterate Applicant and Minors who
    Marital Status MARRIED cannot sign.

    Citizenship of India by BIRTH

    PAN CYBPM5377B

    Voter Id SHZ1980879

    Employment Type SELF EMPLOYED

    Is either of your parent (in case of


    Y
    minor)/spouse, a government servant?

    Educational Qualification BETWEEN 8TH AND 9TH STANDARD

    Are you eligible for Non-ECR category? N

    Aadhaar Number 723132911558

    Family Details
    Father's Name AKADDES MAJHI

    Mother's Name JHORNA MAJHI

    Spouse's Name NAJMA MAJHI


    Present Residential Address Details
    3NO CHARAVIDYA, CHARAVIDYA, BASANTI, BARUIPUR, WEST
    Address
    BENGAL

    PIN 743329

    Police Station BASANTI

    Mobile/Tel No. 7908995591

    E-mail AJIJULMAJHI786@GMAIL.COM
    Permanent Residential Address
    3NO CHARAVIDYA, CHARAVIDYA, BASANTI, BARUIPUR, WEST
    Address
    BENGAL

    PIN 743329

    Police Station BASANTI

    Mobile/Tel No. 7908995591


    Emergency Contact Details
    Name and Address MOJAHEHUR GAZI, TITKUMAR

    Mobile/Tel No. 9134058215


    Other Details
    Payment Details
    Mode of Payment UPI

    Date 10/02/2024

    Receipt/Reference No. CPADMYKBO9

    Amount Received (Rs.) 1500.00 (ONE THOUSAND FIVE HUNDRED ONLY)


    Enclosures
    1.PAN Card issued by the Income Tax Department

    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 CARAVIDYA Signature/Left Hand Thumb Impression of


    Applicant (If applicant is minor, either parent
    Date 10/02/2024 to sign)

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