12/26/2020 View/Print Submitted Form
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 20-0008473930
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name ASHOK CHAUDHARY
Date of Birth (DD/MM/YYYY) 05/07/1985
Validity Required NA
Place of Birth (Village/Town/City) NEW DELHI
District SOUTH DELHI
State/UT DELHI
Country INDIA
Signature/Left Hand Thumb Impression
Gender MALE of Illiterate Applicant and Minors who
Marital Status MARRIED cannot sign.
Citizenship of India by BIRTH
PAN AKIPA1632N
Employment Type PRIVATE
Is either of your parent (in case of
N
minor)/spouse, a government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark A MOLE ON LEFT EAR
Aadhaar Number 546657017848
Family Details
Father's Name SAHAB SINGH
Mother's Name JAGBIRI DEVI
Spouse's Name NISHA CHAUDHARY
https://portal1.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=20-0008473930 1/3
12/26/2020 View/Print Submitted Form
Present Residential Address Details
HOUSE NO 454 GALI 01 BLOCK D SANGAM VIHAR, NEW
Address
DELHI, SOUTH DELHI, DELHI
PIN 110062
Police Station SANGAM VIHAR
Mobile/Tel No. 9540889991
E-mail ASHOKCH36@GMAIL.COM
Permanent Residential Address
HOUSE NO 454 GALI 01 BLOCK D SANGAM VIHAR, NEW
Address
DELHI, SOUTH DELHI, DELHI
PIN 110062
Police Station SANGAM VIHAR
Mobile/Tel No. 9540889991
Emergency Contact Details
ASHOK CHAUDHARY HOUSE NO 454 GALI 01 BLOCK D
Name and Address
SANGAM VIHAR
Mobile/Tel No. 9540889991
E-mail ASHOKCH36@GMAIL.COM
Other Details
Fee Details (Not to be filled by applicants submitting the application at Passport Seva Kendra/Passport Office)
Fee amount in (Rs)
If paid by Demand Draft(DD), provide the following details
DD Issue Date (dd/mm/yyyy)
DD Expiry Date (dd/mm/yyyy)
Bank Name
Branch
Enclosures
1.PAN Card issued by the Income Tax Department
2.Aadhaar Card/e-Aadhar containing the 12 digit Aadhaar number issued by the Unique Identification Authority of India(UIDAI)
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.
Signature/Left Hand Thumb Impression of
https://portal1.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=20-0008473930 2/3
12/26/2020 View/Print Submitted Form
Place SOUTH DELHI Applicant (If applicant is minor, either
parent to sign)
Date 26/12/2020
https://portal1.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=20-0008473930 3/3
