PLEASE FILL UP THIS FORM IN CAPITAL LETTERS ONLY
- Name of Applicant - _________________________________________________________
Surname first name middle name
- In case of change of name / surname, please indicate the previous name / surname in full
__________________________________________________________________
₃
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Sex : Male / Female.
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Date of Birth: ________/______/________
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D D/
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M M/Y Y Y Y
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₃
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Place of Birth: ______________________________________________________________
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Village / Town
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District
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State
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₃ Father’s Full Name: ___________________________________________________
₃ Mother’s Full Name: __________________________________________________
₃ Full Name of Spouse:__________________________________________________
₃ Current Residential Address (where staying presently, with pin code ) :
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
- Telephone No. - _______________________ Mobile ______________________
- Residing Since on above mention address :_________/______/ ________________
DD / MM / Y Y Y Y
₃ If you have been resident at your current address for less than one year, please mention other addresses of your residence during the last one year.
________________________________________________________________________
________________________________________________________________________
· Residing Since on above mention address: FROM ___ /____/____ TO ___ /____/______
DD / MM / Y Y Y Y DD / MM / Y Y Y Y
· Permanent Address with PIN code:
_________________________________________________________________________
__________________________________________________________________________
₃ Educational Qualification: _______________Height: _______cms. Profession: _________
₃ Details of Old Passport: Passport No. _________________ Date of Issue _______________
Place of Issue ________________ Date of Expiry ______________
₃ Are any criminal proceedings pending against you before a court in India? If YES, give name of court, case number and relevant sections of Law.
________________________________________________________________________________
₃ Names and Addresses of two responsible persons : ( NOT RELATIVES )
(2) Name: _______________________________ ( 2 ) __________________________________
Address: _______________________________
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__________________________________
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_______________________________
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__________________________________
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* PLS CLEAR YOUR POLICE VERIFICATION IN TIME TO AVOID DELAY & PENALTY
The information given by me in this form is true and I am solely responsible for its accuracy. I am aware that it is an offence under the Passports Act, 1967 to furnish any false information or to suppress any material information with a view to obtaining a passport or any other travel document.
Date: ___________
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Signature of applicant
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Place: _____________
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______________________
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DOCUMENTS REQUIRED FOR FRESH PASSPORT
ADDRESS PROOF:
You are required to submit atleast 1 of the documents listed below.
1. Water Bill
2. Telephone (landline or post paid mobile bill)
3. Electricity bill
4. One year statement (with transactions)/ Passbook of running bank account
(Scheduled Commercial bank excluding Regional Rural banks and local area
banks)
5. Income Tax Assessment Order
6. Election Commission Photo ID card
7. Proof of Gas Connection
8. Certificate from Employer of reputed companies on letter head
9. Spouse's passport copy (First and last page including family details), (provided
the applicant's present address matches the address mentioned in the spouses
passport)
10. Applicant's current and valid ration card
11. Parent's passport copy, in case of Minors(First and last page)
12. Aadhaar Card
Note (For Document No. 1, 2, and 3) : Atleast 2 bills are required - One bill should of be of last year and the other bill of current year.
Note (For Document No. 8) : Only public limited companies can give address proof on company letter head along with seal. Computerised print-outs shall not be entertained.
Note (For Document No. 10) : If any applicant submits only ration card as proof of address, it should be accompanied by one more proof of address out of the given categories.
PROOF OF DATE OF BIRTH
You are required to submit atleast 1 of the documents listed below.
1. Birth certificate issued by a Municipal Authority or any office authorized to issue Birth
and Death Certificate by the Registrar of Births & Deaths
(Mandatory if birth is after 26.01.1989)
2. School leaving certificate / Secondary School leaving certificate/ Certificate of
Recognized Boards from the school last attended by the applicant or any other
recognized educational institution
3. Affidavit sworn before a Magistrate/Notary stating date/place of birth as per the
specimen in Annexure 'A' by illiterate or semi-illiterate applicants
(Less than 5th class).
