PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 24-0018251356
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name SHEHNAZ ABDUL KARIM KHATRI
Date of Birth (DD/MM/YYYY) 23/07/1971
Validity Required NA
Place of Birth (Village/Town/City) MUMBAI
District THANE RURAL MB-VV
State/UT MAHARASHTRA
Region/Country INDIA
Gender FEMALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN BGCPK0553P
Employment Type HOME MAKER
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification BETWEEN 8TH AND 9TH STANDARD
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark NO
Aadhaar Number 556811064522
Family Details
Father's Name SHARIF KASAM KHATRI
Mother's Name ZAINAB SHARIF KHATRI
Spouse's Name ABDUL KARIM I KHATRI
Present Residential Address Details
403,HUSSAIN NIYAZ CHS LTD ALIBAGH ROAD,UTTAN, MUMBAI, THANE RURAL
Address
MB-VV, MAHARASHTRA
PIN 401106
Police Station UTTAN
Mobile/Tel No. 08879948451 / 9833759612
E-mail SHAHNAZKHATRI6@GMAIL.COM
Permanent Residential Address
403,HUSSAIN NIYAZ CHS LTD ALIBAGH ROAD,UTTAN, MUMBAI, THANE RURAL
Address
MB-VV, MAHARASHTRA
PIN 401106
Police Station UTTAN
Mobile/Tel No. 08879948451 / 9833759612
Emergency Contact Details
Name and Address NAWAZ RAHIM SAYYED
Mobile/Tel No. 8108467184
E-mail R2344134@GMAIL.COM
Other Details
Enclosures
1.PAN Card issued by the Income Tax Department
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 UTTAN NAKA
Date 29/10/2024
