1/6/2021 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 21-1000136457
Applying For FRESH
Type of Application TATKAAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name HARISH VUNNAM
Date of Birth (DD/MM/YYYY) 07/12/1996
Validity Required NA
Place of Birth (Village/Town/City) DURGI
District GUNTUR RURAL
State/UT ANDHRA PRADESH
Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
Employment Type OTHERS
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? N
Visible Distinguishing Mark A MOLE ON THE RIGHT CHEEK
Aadhaar Number 435946909289
Family Details
Father's Name VEERA SWAMI VUNNAM
Mother's Name KOTESWARAMMA VUNNAM
Present Residential Address Details
1-32,VUNNAM VARI BAZAR, DHARMAVARAM, GUNTUR RURAL,
Address
ANDHRA PRADESH
PIN 522612
Police Station DURGI
Mobile/Tel No. 7702584577
E-mail HARISHVUNNAM581@GMAIL.COM
Permanent Residential Address
1-32,VUNNAM VARI BAZAR, DHARMAVARAM, GUNTUR RURAL,
Address
ANDHRA PRADESH
PIN 522612
Police Station DURGI
Mobile/Tel No. 7702584577
Emergency Contact Details
Name and Address M SRIKANTH,GUTTIKONDA
Mobile/Tel No. 9966595302
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 & 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

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1/6/2021 Application Form
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 DURGI
Date 06/01/2021

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