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    SHREEVA - Print Submitted Form

    Uploaded by

    Dhaval Godhani

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    SHREEVA - Print Submitted Form

    Uploaded by

    Dhaval Godhani
    14 views2 pages

    Original Title

    SHREEVA_Print Submitted Form

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    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

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

    SHREEVA - Print Submitted Form

    Uploaded by

    Dhaval Godhani

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    6/13/24, 1:49 PM View/Print Submitted Form

    File Number (For Office Use Only)

    GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS

    PASSPORT APPLICATION FORM

    Please read the Passport Instruction Booklet carefully before filling the form. Fill this form in CAPITAL LETTERS using
    blue/black ink ball point pen only. Furnishing of incorrect information/ suppression of information would lead to rejection of the
    application and would attract penal provisions as prescribed under the Passports Act, 1967. Please produce your original
    documents at the time of submission of the form.

    Service Required
    Application Reference Number 24-0010370852

    Applying For FRESH

    Type of Application NORMAL

    Type of Passport Booklet NORMAL


    Applicant Details
    Applicant's Name SHREEVA DHAVALKUMAR GODHANI

    Date of Birth (DD/MM/YYYY) 18/12/2021

    Validity Required NA

    Place of Birth (Village/Town/City) RAJKOT

    District RAJKOT

    State/UT GUJARAT

    Region/Country INDIA
    Signature/Left Hand Thumb Impression
    Gender FEMALE of Illiterate Applicant and Minors who
    Marital Status SINGLE cannot sign.

    Citizenship of India by BIRTH

    Employment Type NOT EMPLOYED

    Is either of your parent (in case of


    N
    minor)/spouse, a government servant?

    Educational Qualification 7TH PASS OR LESS

    Are you eligible for Non-ECR category? N

    Aadhaar Number 394689749147

    Family Details
    Father's Name DHAVALKUMAR VASHRAMBHAI GODHANI

    Mother's Name BANSI DHAVALKUMAR GODHANI

    Father/Legal guardian's File/Passport Number T5856782


    Present Residential Address Details
    BOMBAYHOUSING SOCIETY MAIN ROAD UNIVERISTY
    Address
    ROAD, RAJKOT, RAJKOT, GUJARAT

    PIN 360005

    Police Station GANDHIGRAM 2 (UNI)

    https://portal1.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=24-0010370852 1/2
    6/13/24, 1:49 PM View/Print Submitted Form

    Mobile/Tel No. 09998588333

    E-mail [email protected]
    Permanent Residential Address
    BOMBAYHOUSING SOCIETY MAIN ROAD UNIVERISTY
    Address
    ROAD, RAJKOT, RAJKOT, GUJARAT

    PIN 360005

    Police Station GANDHIGRAM 2 (UNI)

    Mobile/Tel No. 09998588333


    Emergency Contact Details
    DRDHAVALPATELSALUS HOSPITALS RAIYA ROAD RAIYA
    Name and Address
    CIRCLE

    Mobile/Tel No. 09998588333

    E-mail [email protected]
    Other Details
    Fee Details (Not to be filled by applicants submitting the application at Passport Seva Kendra/Passport Office)
    Fee amount in (Rs)

    If paid by Demand Draft(DD), provide the following details

    DD Issue Date (dd/mm/yyyy)

    DD Expiry Date (dd/mm/yyyy)

    Bank Name

    Branch
    Enclosures
    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 RAJKOT Signature/Left Hand Thumb Impression of


    Applicant (If applicant is minor, either parent
    Date 13/06/2024 to sign)

    https://portal1.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=24-0010370852 2/2

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