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Application Form

This document is a passport application form for Abhijeet Tiwari, requesting a fresh normal passport. The applicant is a 28-year-old male from Bilaspur, Chhattisgarh, and is self-employed with a graduate education. The application includes personal details, family information, and a self-declaration of allegiance to India.

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12 views1 page

Application Form

This document is a passport application form for Abhijeet Tiwari, requesting a fresh normal passport. The applicant is a 28-year-old male from Bilaspur, Chhattisgarh, and is self-employed with a graduate education. The application includes personal details, family information, and a self-declaration of allegiance to India.

Uploaded by

amitesh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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6/26/2018 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 18-0009887350
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name ABHIJEET TIWARI
Date of Birth (DD/MM/YYYY) 17/05/1990
Validity Required NA
Place of Birth (Village/Town/City) BILASPUR
District BILASPUR
State/UT CHHATTISGARH
Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN AWRPT1328H
Employment Type SELF EMPLOYED
Is either of your parent (in case of minor)/spouse,
Y
a government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 775197815895
Family Details
Father's Name HIMANSHU TIWARI
Mother's Name ALKA TIWARI
Present Residential Address Details
SEC-2, GANGA NAGAR NEAR SHIV MANDIR,MANGLA CHOWK, BILASPUR,
Address
CIVILE LINE, BILASPUR, CHHATTISGARH
PIN 495001
Mobile/Tel No. 9644339900 / 07752408683
E-mail ABHIJEET.1790@HOTMAIL.COM
Permanent Residential Address
SEC-2, GANGA NAGAR NEAR SHIV MANDIR,MANGLA CHOWK, BILASPUR,
Address
CIVILE LINE, BILASPUR, CHHATTISGARH
PIN 495001
Mobile/Tel No. 9644339900 / 07752408683
Emergency Contact Details
YOGESH PATEL, GANPATI PLY SHOP, MUNGELI ROAD, MANGLA CHOWK
Name and Address
BILASPUR
Mobile/Tel No. 9827932222
Other Details
Enclosures
1.Aadhaar Card/E-Aadhaar
2.Aadhaar Card
Self Declaration
I owe allegiance to the sovereignty, unity and 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 and I affirm that the information given by me in this
form and the enclosures is true and I am solely responsible for its accuracy, and 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.
Place BILASPUR
Date 26/06/2018

https://portal1.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 1/1

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