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 23-0006010426
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name JITENDRA KUMAR PANDEY
Date of Birth (DD/MM/YYYY) 28/01/1986
Validity Required NA
Place of Birth (Village/Town/City) MAISAHAN
District MUZAFFARPUR
State/UT BIHAR
Region/Country INDIA
Signature/Left Hand Thumb Impression
Gender MALE of Illiterate Applicant and Minors who
Marital Status DIVORCED cannot sign.
Citizenship of India by BIRTH
PAN AUMPP3244R
Employment Type GOVERNMENT
Organisation name INDIAN AIR FORCE
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? N
Visible Distinguishing Mark CUT MARK ON CHIN
Aadhaar Number 942847416844
Family Details
Father's Name JAGANNATH PANDEY
Mother's Name ANANDI DEVI
Present Residential Address Details
612 GARUD FLIGHT, AIR FORCE STN CHANDINAGAR, BAGHPAT,
Address
UTTAR PRADESH
PIN 250615
Police Station CHANDINAGAR
Mobile/Tel No. 7063347654
E-mail JITENDRAPANDEY53@YAHOO.CO.IN
Permanent Residential Address
Address MAISAHAN, MAISAHAN, MUZAFFARPUR, BIHAR, INDIA
PIN 843109
Police Station KANTI
Mobile/Tel No. 7063347654
Emergency Contact Details
JAGANNATH PANDEY MAISAHAN, SINGAR PHULKAHAN,
Name and Address
KANTI, MUZAFFARPUR BIHAR
Mobile/Tel No. 9934293083
Have you ever applied for passport, but not issued?
File Number GZ1066122018422
Date of Issue 28/12/2021
Name of passport office where applied SAHIBABAD
Details of Previous/Current Diplomatic/Official Passport
Passport Number O1629552
Date of Issue 03/09/2021
Date of Expiry 02/09/2026
Place of Issue NEW DELHI
Other Details
Payment Details
Mode of Payment Online/Internet Banking
Date 01/04/2023
Receipt/Reference No. IGAPJJMEV5
Amount Received (Rs.) 1500.00 (ONE THOUSAND FIVE HUNDRED ONLY)
Enclosures
1.Aadhaar Card/E-Aadhaar
2.Driving Licenses (valid and within the jurisdiction of state of submission of application)
3.No Objection Certificate (NOC) as per Annexure G
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 CHANDINAGAR Signature/Left Hand Thumb Impression of
Applicant (If applicant is minor, either parent
Date 01/04/2023 to sign)
Print Close
