Application Form https://portal2.passportindia.gov.in/AppOnlineProject/secure/Applican...
PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 24-1009509609
Applying For REISSUE
If Re-issue, specify reason(s) VALIDITY EXPIRED WITHIN 3 YEARS/DUE TO EXPIRE.
Type of Application TATKAAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name RASHEED KARAPPAMVEETTIL KABEER
Date of Birth (DD/MM/YYYY) 21/04/1985
Validity Required NA
Place of Birth (Village/Town/City) PERINGOTTUKARA
District THRISSUR RURAL
State/UT KERALA
Region/Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
Employment Type SELF EMPLOYED
Is either of your parent (in case of minor)/
N
spouse, a government servant?
Educational Qualification BETWEEN 8TH AND 9TH STANDARD
Are you eligible for Non-ECR category? N
Family Details
Father's Name KARAPPAMVEETTIL HYDROSE KABEER
Mother's Name MURITHARA AMMUKUNJI AYISHABI
Spouse's Name BENAZEER RASHEED
Present Residential Address Details
KARAPPAMVEETTIL HOUSE,PERINGOTTUKARA P O, THANNIAM, THRISSUR
Address
RURAL, KERALA
PIN 680565
Police Station ANTHIKAD
Mobile/Tel No. 9946377650
E-mail KABEERRASHEED43@GMAIL.COM
Permanent Residential Address
KARAPPAMVEETTIL HOUSE,PERINGOTTUKARA P O, THANNIAM, THRISSUR
Address
RURAL, KERALA
PIN 680565
Police Station ANTHIKAD
Mobile/Tel No. 9946377650
Emergency Contact Details
Name and Address RASHEED K K
Mobile/Tel No. 9946377650
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number M2501936
Date of Issue 22/09/2014
Date of Expiry 21/09/2024
Place of Issue COCHIN
File Number CO5077946508314
Other Details
Enclosures
1.Transfer/School leaving/Matriculation Certificate issued by the school last attended/recognized educational board
2.Aadhaar Card (Address Proof)
Self Declaration
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Application Form https://portal2.passportindia.gov.in/AppOnlineProject/secure/Applican...
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 PERINGOTTUKARA
Date 27/07/2024
2 of 2 27-07-2024, 17:38
