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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 22-0016900514
Applying For REISSUE
VALIDITY EXPIRED WITHIN 3
If Re-issue, specify reason(s)
YEARS/DUE TO EXPIRE.
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name RAMAKANT SHARMA
Date of Birth (DD/MM/YYYY) 15/08/1987
Validity Required NA
Place of Birth (Village/Town/City) BORAJ
District JAIPUR RURAL
State/UT RAJASTHAN Signature/Left Hand Thumb Impression
of Illiterate Applicant and Minors who
Region/Country INDIA cannot sign.
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN EFMPS7881J
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
Visible Distinguishing Mark MARK ON RIGHT KNEE
Aadhaar Number 924565351132
Family Details
Father's Name PREMSHANKAR SHARMA
Mother's Name GEETA DEVI SHARMA
Spouse's Name POOJA JOSHI
Present Residential Address Details
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Address RAMAKANT SHARMA, LUHARO KA MOHALLA, BORAJ,
JAIPUR RURAL, RAJASTHAN
PIN 303338
Police Station MOZMABAD
Mobile/Tel No. 9007772374
E-mail RAMAKANTSHARMA.BIT@GMAIL.COM
Permanent Residential Address
RAMAKANT SHARMA, LUHARO KA MOHALLA, BORAJ,
Address
JAIPUR RURAL, RAJASTHAN
PIN 303338
Police Station MOZMABAD
Mobile/Tel No. 9007772374
Emergency Contact Details
Name and Address RAVINDRA SHARMA
Mobile/Tel No. 9983607272
E-mail RAMAKANT15SHARMA08@GMAIL.COM
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number K5828689
Date of Issue 13/07/2012
Date of Expiry 12/07/2022
Place of Issue JAIPUR
Other Details
Payment Details
Mode of Payment UPI
Date 03/10/2022
Receipt/Reference No. CPACCDBTZ8
Amount Received (Rs.) 1500.00 (ONE THOUSAND FIVE HUNDRED ONLY)
Enclosures
1.Aadhaar Card/E-Aadhaar
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.
Signature/Left Hand Thumb Impression of
Place JAIPUR Applicant (If applicant is minor, either parent
to sign)
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Date 03/10/2022
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