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    Jay Narang
    This document is a passport application form for Jay Trilok Narang, who is applying for a fresh normal passport. The application includes personal details such as date of birth, address, and family information, as well as a declaration affirming the accuracy of the provided information. Payment of Rs. 1500 has been made via UPI, and necessary enclosures like PAN and Aadhaar cards are included.

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    This document is a passport application form for Jay Trilok Narang, who is applying for a fresh normal passport. The application includes personal details such as date of birth, address, and family information, as well as a declaration affirming the accuracy of the provided information. Payment of Rs. 1500 has been made via UPI, and necessary enclosures like PAN and Aadhaar cards are included.

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    This document is a passport application form for Jay Trilok Narang, who is applying for a fresh normal passport. The application includes personal details such as date of birth, address, and family information, as well as a declaration affirming the accuracy of the provided information. Payment of Rs. 1500 has been made via UPI, and necessary enclosures like PAN and Aadhaar cards are included.

    Copyright:

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

    View_Print Submitted Form

    Uploaded by

    Jay Narang
    This document is a passport application form for Jay Trilok Narang, who is applying for a fresh normal passport. The application includes personal details such as date of birth, address, and family information, as well as a declaration affirming the accuracy of the provided information. Payment of Rs. 1500 has been made via UPI, and necessary enclosures like PAN and Aadhaar cards are included.

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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 25-0000959358

    Applying For FRESH

    Type of Application NORMAL

    Type of Passport Booklet NORMAL


    Applicant Details

    Applicant's Name JAY TRILOK NARANG

    Date of Birth (DD/MM/YYYY) 10/07/1993

    Validity Required NA

    Place of Birth (Village/Town/City) SHRIRAMPUR

    District AHMEDNAGAR

    State/UT MAHARASHTRA

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

    Citizenship of India by BIRTH

    PAN APXPN5572J

    Employment Type PRIVATE

    Is either of your parent (in case of


    N
    minor)/spouse, a government servant?

    Educational Qualification GRADUATE AND ABOVE

    Are you eligible for Non-ECR category? Y

    Aadhaar Number 692208667675

    Family Details

    Father's Name TRILOK NANAKCHAND NARANG

    Mother's Name SUNITA TRILOK NARANG


    Present Residential Address Details

    TRILOK BUILDING, WARD NO.1 , TAMBE CHAL, SHRIRAMPUR,


    Address
    AHMEDNAGAR, MAHARASHTRA

    PIN 413709

    Police Station SHRIRAMPUR CITY


    Mobile/Tel No. 7977234668

    E-mail JAYNARANG9123@GMAIL.COM
    Permanent Residential Address

    TRILOK BUILDING, WARD NO.1 , TAMBE CHAL, SHRIRAMPUR,


    Address
    AHMEDNAGAR, MAHARASHTRA

    PIN 413709

    Police Station SHRIRAMPUR CITY

    Mobile/Tel No. 7977234668


    Emergency Contact Details

    Name and Address JAY TRILOK NARANG R/A- SHRIRAMPUR

    Mobile/Tel No. 7977234668

    E-mail JAYNARANG9123@GMAIL.COM
    Other Details
    Payment Details

    Mode of Payment UPI

    Date 16/01/2025

    Receipt/Reference No. CPAERXNQE0

    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 SHRIRAMPUR Signature/Left Hand Thumb Impression of


    Applicant (If applicant is minor, either parent
    Date 16/01/2025 to sign)

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