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    Mim Passport Application Form

    Uploaded by

    shraya.saha02

    Copyright:

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

    Mim Passport Application Form

    Uploaded by

    shraya.saha02
    9 views2 pages

    Copyright

    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
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    Download as pdf or txt
    9 views2 pages

    Mim Passport Application Form

    Uploaded by

    shraya.saha02

    Copyright:

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

    6/18/23, 6:54 AM Application Form

    PASSPORT APPLICATION FORM

    Government of INDIA, Ministry of External Affairs

    Service Required
    Application Reference Number 23-1007585303
    Applying For FRESH
    Type of Application NORMAL
    Type of Passport Booklet NORMAL
    Applicant Details
    Applicant's Name SHREJA SAHA
    Date of Birth (DD/MM/YYYY) 06/04/2005
    Validity Required NA
    Place of Birth (Village/Town/City) CHHOTPARUA
    District RAIGANJ
    State/UT WEST BENGAL
    Region/Country INDIA
    Gender FEMALE
    Marital Status SINGLE
    Citizenship of India by BIRTH
    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
    Visible Distinguishing Mark BROWNMARK IN LEFT CORNEA OF THE EYE
    Aadhaar Number 540220338988
    Family Details
    Father's Name MADAN GOPAL SAHA
    Mother's Name SHARMISTHA SAHA
    Present Residential Address Details
    Address KAMAL APARTMENTS, FLOOR 3, RAIGANJ, RAIGANJ, WEST BENGAL
    PIN 733134
    Police Station RAIGANJ
    Mobile/Tel No. 9800048458
    E-mail SREEJA.SAHA06@GMAIL.COM
    Permanent Residential Address
    Address KAMAL APARTMENTS, FLOOR 3, RAIGANJ, RAIGANJ, WEST BENGAL
    PIN 733134
    Police Station RAIGANJ
    Mobile/Tel No. 9800048458
    Emergency Contact Details
    Name and Address MADAN GOPAL SAHA
    Mobile/Tel No. 8972152728
    Other Details
    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)
    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

    https://portal2.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 1/2
    6/18/23, 6:54 AM Application Form
    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 RAIGANJ
    Date 18/06/2023

    https://portal2.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 2/2

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