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    Passport Application Form Government of INDIA, Ministry of External Affairs

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    Tamoghna Rokade
    Tamoghna Chira Rokade has submitted a passport application form for a reissue as his passport expired within 3 years. He is applying for a normal passport as a 10-year old Indian citizen born in Mumbai, Maharashtra. He lists his parents' and his own personal details including address, contact information, and aadhar number. He also provides details of his expired passport and encloses his aadhar card with the application. He signs a self-declaration affirming the accuracy of the information provided in the application form.

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    Passport Application Form Government of INDIA, Ministry of External Affairs

    Uploaded by

    Tamoghna Rokade
    90 views2 pages
    Tamoghna Chira Rokade has submitted a passport application form for a reissue as his passport expired within 3 years. He is applying for a normal passport as a 10-year old Indian citizen born in Mumbai, Maharashtra. He lists his parents' and his own personal details including address, contact information, and aadhar number. He also provides details of his expired passport and encloses his aadhar card with the application. He signs a self-declaration affirming the accuracy of the information provided in the application form.

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    application

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    Tamoghna Chira Rokade has submitted a passport application form for a reissue as his passport expired within 3 years. He is applying for a normal passport as a 10-year old Indian citizen born in Mumbai, Maharashtra. He lists his parents' and his own personal details including address, contact information, and aadhar number. He also provides details of his expired passport and encloses his aadhar card with the application. He signs a self-declaration affirming the accuracy of the information provided in the application form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    90 views2 pages

    Passport Application Form Government of INDIA, Ministry of External Affairs

    Uploaded by

    Tamoghna Rokade
    Tamoghna Chira Rokade has submitted a passport application form for a reissue as his passport expired within 3 years. He is applying for a normal passport as a 10-year old Indian citizen born in Mumbai, Maharashtra. He lists his parents' and his own personal details including address, contact information, and aadhar number. He also provides details of his expired passport and encloses his aadhar card with the application. He signs a self-declaration affirming the accuracy of the information provided in the application form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Application Form 30/07/19, 5*26 PM

    PASSPORT APPLICATION FORM

    Government of INDIA, Ministry of External Affairs

    Service Required
    Application Reference Number 19-0010715932
    Applying For REISSUE
    If Re-issue, specify reason(s) VALIDITY EXPIRED WITHIN 3 YEARS/DUE TO EXPIRE.
    Type of Application NORMAL
    Type of Passport Booklet NORMAL
    Applicant Details
    Applicant's Name TAMOGHNA CHIRAG ROKADE
    Date of Birth (DD/MM/YYYY) 19/11/2009
    Validity Required NA
    Place of Birth (Village/Town/City) MUMBAI
    District MUMBAI
    State/UT MAHARASHTRA
    Country INDIA
    Gender MALE
    Marital Status SINGLE
    Citizenship of India by BIRTH
    Employment Type STUDENT
    Is either of your parent (in case of minor)/spouse, a
    N
    government servant?
    Educational Qualification 7TH PASS OR LESS
    Are you eligible for Non-ECR category? N
    Aadhaar Number 222731243373
    Family Details
    Father's Name CHIRAG UMAKANT ROKADE
    Mother's Name KENITA CHIRAG ROKADE
    Father/Legal guardian's File/Passport Number Z2678576
    Mother/Legal guardian's File/Passport Number H7521685
    Present Residential Address Details
    128/4545, TRIBHUVAN CHS, NEW TILAK NAGAR, CHEMBU, MUMBAI,
    Address
    MUMBAI, MAHARASHTRA
    PIN 400089
    Police Station TILAK NAGAR
    Mobile/Tel No. 9892599176
    E-mail [email protected]
    Permanent Residential Address
    128/4545, TRIBHUVAN CHS, NEW TILAK NAGAR, CHEMBU, MUMBAI,
    Address
    MUMBAI, MAHARASHTRA
    PIN 400089
    Police Station TILAK NAGAR
    Mobile/Tel No. 9892599176
    Emergency Contact Details
    Name and Address KENITA ROKADE
    Mobile/Tel No. 9867648851
    E-mail [email protected]
    Previous Passport
    Details of latest held/existing/lost/damaged Ordinary Passport
    Passport Number M3086349
    Date of Issue 20/10/2014
    Date of Expiry 19/10/2019

    https://portal1.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction Page 1 of 2
    Application Form 30/07/19, 5*26 PM

    Place of Issue MUMBAI


    Other Details
    Enclosures
    1.Aadhaar Card/E-Aadhaar
    2.Aadhaar Card/e-Aadhar containing the 12 digit Aadhaar number issued by the Unique Identification Authority of India(UIDAI)
    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 MUMBAI
    Date 30/07/2019

    https://portal1.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction Page 2 of 2

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