4/4/24, 3:05 PM Application Form
PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 24-0005939488
Applying For REISSUE
If Re-issue, specify reason(s) CHANGE IN EXISTING PERSONAL PARTICULARS
If change in existing personal particulars, specify ADDRESS
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name ARUN KUMAR SHAW
Date of Birth (DD/MM/YYYY) 22/03/1985
Validity Required NA
Place of Birth (Village/Town/City) KOLKATA
District KOLKATA
State/UT WEST BENGAL
Region/Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN CCXPS5830F
Voter Id YCT5584750
Employment Type PRIVATE
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark A MOLE ON NOSE
Aadhaar Number 573594200209
Family Details
Father's Name RAMDEO SHAW
Mother's Name DULARI DEVI
Spouse's Name SHALINI ARUN SHAW
Present Residential Address Details
B 216 ,SNEH CHS LTD. TEMBODE ROAD,VRINDAVAN PARK, PALGHAR,
Address
PALGHAR, MAHARASHTRA
PIN 401404
Police Station PALGHAR
Mobile/Tel No. 9284325073
E-mail KUMAR22AKS@GMAIL.COM
Permanent Residential Address
B 216 ,SNEH CHS LTD. TEMBODE ROAD,VRINDAVAN PARK, PALGHAR,
Address
PALGHAR, MAHARASHTRA
PIN 401404
Police Station PALGHAR
Mobile/Tel No. 9284325073
Emergency Contact Details
RAMDEO SHAW AND G-01 PRAGATI APARTMENT , GIDC COLONY
Name and Address
UMBERGAON , DIST VALSAD 396171
Mobile/Tel No. 9330818751
E-mail SHAWARUN9@GMAIL.COM
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number L8315069
Date of Issue 25/03/2014
Date of Expiry 24/03/2024
Place of Issue THANE , VASAI
File Number TH2067444666213
Other Details
Enclosures
https://portal1.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 1/2
4/4/24, 3:05 PM Application Form
1.Birth certificate issued by the Registrar of Births and Deaths or the Municipal Corporation or any other prescribed authority
whosoever has been empowered under the Registration of Birth and Deaths Act, 1969 to register the birth of a child born in India
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 PALGHAR
Date 04/04/2024
https://portal1.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 2/2
