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    Madhu Passport Application

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    voiceofminds.15

    Copyright:

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

    Madhu Passport Application

    Uploaded by

    voiceofminds.15
    2 views1 page

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    Copyright:

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    2 views1 page

    Madhu Passport Application

    Uploaded by

    voiceofminds.15

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    PASSPORT APPLICATION FORM

    Government of INDIA, Ministry of External Affairs

    Service Required
    Application Reference Number 24-1014869493
    Applying For FRESH
    Type of Application NORMAL
    Type of Passport Booklet NORMAL
    Applicant Details
    Applicant's Name MADHU A V
    Date of Birth (DD/MM/YYYY) 08/07/1987
    Validity Required NA
    Place of Birth (Village/Town/City) CHANNAPATNA
    District RAMANAGAR
    State/UT KARNATAKA
    Region/Country INDIA
    Gender MALE
    Marital Status MARRIED
    Citizenship of India by BIRTH
    PAN CEIPM6874E
    Employment Type PRIVATE
    Is either of your parent (in case of minor)/spouse, a
    N
    government servant?
    Educational Qualification GRADUATE AND ABOVE
    Are you eligible for Non-ECR category? Y
    Family Details
    Father's Name VEEREGOWDA
    Mother's Name THAYAMMA
    Spouse's Name SUMALATHA AKKURU RAJA GURU
    Present Residential Address Details
    AGRAHARA VALAGEREHALLI, CHANNAPATNA, RAMANAGAR,
    Address
    KARNATAKA
    PIN 562160
    Police Station CHANNAPATANA RURAL
    Mobile/Tel No. 9980719819
    E-mail MADHUAV87@GMAIL.COM
    Permanent Residential Address
    AGRAHARA VALAGEREHALLI, CHANNAPATNA, RAMANAGAR,
    Address
    KARNATAKA
    PIN 562160
    Police Station CHANNAPATANA RURAL
    Mobile/Tel No. 9980719819
    Emergency Contact Details
    Name and Address SUMALATHA A R
    Mobile/Tel No. 9844580472
    Other Details
    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 CHANNAPATNA
    Date 07/12/2024

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