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Application Form PDF

Raghav Jethliya has applied for a fresh Indian passport under the Tatkaal scheme. He has provided details such as his name, date of birth, place of birth, address, father and mother's name, employment and educational details. He has enclosed his Aadhaar card and rent agreement with the application. In a self-declaration, he affirms his allegiance to India and that the information provided is true to the best of his knowledge.

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129 views1 page

Application Form PDF

Raghav Jethliya has applied for a fresh Indian passport under the Tatkaal scheme. He has provided details such as his name, date of birth, place of birth, address, father and mother's name, employment and educational details. He has enclosed his Aadhaar card and rent agreement with the application. In a self-declaration, he affirms his allegiance to India and that the information provided is true to the best of his knowledge.

Uploaded by

madhavmahesh123
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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6/1/2018 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 18-0008396716
Applying For FRESH
Type of Application TATKAAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name RAGHAV JETHLIYA
Date of Birth (DD/MM/YYYY) 26/10/1996
Validity Required NA
Place of Birth (Village/Town/City) INDORE
District INDORE
State/UT MADHYA PRADESH
Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN BROPJ9437N
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
Aadhaar Number 929170164802
Family Details
Father's Name DINESH KUMAR JETHLIYA
Mother's Name VINITA JETHLIYA
Present Residential Address Details
FLAT NO.415-A, TRISHLA APARTMENT, BIYABANI, INDORE, CHHATRIPURA,
Address
INDORE, MADHYA PRADESH
PIN 452002
Mobile/Tel No. 8462851865
E-mail RAGHAVMAHESHWARI.905@REDIFFMAIL.COM
Permanent Residential Address
FLAT NO.415-A, TRISHLA APARTMENT, BIYABANI, INDORE, CHHATRIPURA,
Address
INDORE, MADHYA PRADESH
PIN 452002
Mobile/Tel No. 8462851865
Emergency Contact Details
DINESH JETHLIYA, FLAT NO. 415-A, TRISHLA APARTMENT, BIYABANI,
Name and Address
INDORE
Mobile/Tel No. 9977899289
E-mail MADDYMADHAV222@GMAIL.COM
Other Details
Enclosures
1.Aadhaar Card/E-Aadhaar
2.Rent Agreement
Self Declaration
I owe allegiance to the sovereignty, unity and 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 and I affirm that the information given by me in
this form and the enclosures is true and I am solely responsible for its accuracy, and 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.
Place INDORE
Date 01/06/2018

https://portal1.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 1/1

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