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    Application Form

    Uploaded by

    demonovishal
    Passport

    Copyright:

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

    Application Form

    Uploaded by

    demonovishal
    5 views2 pages
    Passport

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Passport

    Copyright:

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

    Application Form

    Uploaded by

    demonovishal
    Passport

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    PASSPORT APPLICATION FORM

    Government of INDIA, Ministry of External Affairs

    Service Required
    Application Reference Number 23-0022701118
    Applying For FRESH
    Type of Application NORMAL
    Type of Passport Booklet NORMAL
    Applicant Details
    Applicant's Name AKHILESH YADAV
    Date of Birth (DD/MM/YYYY) 10/05/1993
    Validity Required NA
    Place of Birth (Village/Town/City) BANDA
    District BANDA
    State/UT UTTAR PRADESH
    Region/Country INDIA
    Gender MALE
    Marital Status MARRIED
    Citizenship of India by BIRTH
    PAN AOCPY8037M
    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? N
    Visible Distinguishing Mark MOLE NEAR LEFT EYE
    Aadhaar Number 894298926359
    Family Details
    Father's Name BACHCHA YADAV
    Mother's Name SUNITA DEVI
    Spouse's Name SHIVAKANTI
    Present Residential Address Details
    GAYATRI NAGAR, R C C ROAD BANDA, BANDA, UTTAR
    Address
    PRADESH
    PIN 210001
    Police Station KOTWALI NAGAR
    Mobile/Tel No. 9119696912
    E-mail AKYADAV.BANDA@GMAIL.COM
    Permanent Residential Address
    GAYATRI NAGAR, R C C ROAD BANDA, BANDA, UTTAR
    Address
    PRADESH
    PIN 210001
    Police Station KOTWALI NAGAR
    Mobile/Tel No. 9119696912
    Emergency Contact Details
    Name and Address SHIVAKANTI GAYATRI NAGAR BANDA
    Mobile/Tel No. 9260980523
    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 BANDA
    Date 18/12/2023
    Print Close
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