BAITUSSYIFAA, SIMPANG 40-22, JALAN SUNGAI AKAR

BANDAR SERI BEGAWAN, BC 3915, BRUNEI DARUSSALAM

00-673-2339947 https://www.hcindiabrunei.gov.in/
PASSPORT PREVIEW

भारत गणराज्य REPUBLIC OF INDIA

Paste your unsigned recent color photograph of Size 2"X2" and Signature/Left Hand Thumb Impression in the box provided

टाइप/Type राष्ट्र कोड/CountryCode पासपोटर् नं./PassportNo.

P IND
उपनाम/Surname
Paste your unsigned
KARUPAIYAN
recent color photograph
िदया गया नाम/Given Name(s)
Size 2"X2" and
MUHAMMAD FAHIM
Signature/Left Hand
राष्ट्रीयता/Nationality िलं ग/Sex जन्मितिथ/Date of Birth
Thumb Impression in
INDIAN M 18/01/1995
the box provided below
जन्म स्थान/Place of Birth

Generated on: Saturday, October 7, 2023 12:31:27 AM

MELAPOOVANAM TAMILNADU, TAMIL NADU

जारी करने का स्थान/Place of Issue

जारी करने की ितिथ/Date of Issue समािप्त की ितिथ/Date of Expiry

िपता/कानूनी िभभावक का नाम/Name of Father/Legal Guardian

KARUPAIYAN

माता का नाम/Name of Mother

BAKKIYAM

पित या पत्नी का नाम/Name of Spouse

AMMATHUR RAHIMAN

पता/Address

223 THULUKANATHAMMAN KOVIL STREET

KANATHUR REDDYKUPPAM, KANCHIPURAM

PIN:603112, TAMIL NADU, INDIA

पुराने पासपोटर् का नं. और इसके जारी होने की ितिथ एवं स्थान/Old Passport No with Date and Place of Issue

R4259984 19/09/2017 TIRUCHIRAPPALLI

फ़ाइल नं./File No.

Service Required
Application Reference Number (ARN) 23-2003998962
Applying For REISSUE
If Re-issue, specify reason(s) CHANGE IN EXISTING PERSONAL PARTICULARS
If change in existing personal particulars, specify GIVEN NAME
Type of Application NORMAL
Type of Passport Booklet 60 Pages

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 Applicant Details
Applicant's Name MUHAMMAD FAHIM KARUPAIYAN
Applicant's Alias Name N ARUNKUMAR
Applicant's Change In Name Y MUHAMMAD FAHIM
Previous Name1 ARUNKUMAR KARUPAIYAN
Date of Birth (DD/MM/YYYY) 18/01/1995
Validity Required NA
Place of Birth (Village/Town/City) MELAPOOVANAM TAMILNADU
District PUDUKKOTTAI
State/UT TAMIL NADU
Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
Employment Type OTHERS
Is either of your parent (in case of minor)/spouse, a government
servant? N
Educational Qualification BETWEEN 8TH AND 9TH STANDARD
Are you eligible for Non-ECR category? N
Aadhaar Number 481193866281
Family Details(as in passport)
Father's Name KARUPAIYAN
Mother's Name BAKKIYAM
Spouse's Name AMMATHUR RAHIMAN
Passport Printable Address Details
223 THULUKANATHAMMAN KOVIL STREET
To be printed on passport KANATHUR REDDYKUPPAM, KANCHIPURAM
PIN:603112, TAMIL NADU, INDIA
Mobile/Telephone Number 7200179122
E-mail SALEDPT786@GMAIL.COM
Other Address Details
Address 224 THULUKANATHAMMAN KOVIL STREET
KANATHUR REDDYKUPPAM, KANCHIPURAM
PIN:603112, TAMIL NADU, INDIA
Mobile/Telephone Number 9094943808
Emergency Contact Details
ZUBAIR UNIT23 RIMBA COMPLEX KG RIMBA
Name and Address
GADONG BRUNEI
Mobile/Telephone Number 6738196085
E-mail SALEDPT786@GMAIL.COM
Previous Passport
Passport Number R4259984
Date of Issue 19/09/2017
Date of Expiry 18/09/2027
Place of Issue TIRUCHIRAPPALLI
File Number Tr1060525764117
Have you ever applied for passport, but not issued? N
Details of Previous/Current Diplomatic/Official Passport N
Other Details
1) Provide the following details if there are any criminal proceedings pending against the applicant.
1.1) Are any proceedings in respect of an offence alleged to have been committed by you pending before a criminal court in India? N
1.2) Has any warrant or summons for your appearance been issued and pending before a court under any law for the time being in force? N

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 1.3) Has a warrant for your arrest been issued by a court under any law for the time being in force? N
1.4) Has an order prohibiting your departure from India been made by any court? N
2) Provide the following details if the applicant has been convicted by a court in India.
2.1) Have you at any time during the period of five years immediately preceding the date of this application been convicted by a court in India for
any offence involving moral turpitude and sentenced in respect thereof to imprisonment for not less than two years?
N
3) Provide the following details if the applicant has been refused/denied passport.
3.1) Have you ever been refused/denied passport? N
3.2) Has your passport ever been impounded? N
3.3) Has your passport ever been revoked? N
4) Provide the following details if applicant has applied for or been granted foreign citizenship.
4.1) Have you ever applied for or been granted citizenship by any other country? N
4.2) Have you ever held the passport of any other country at any time? N
4.3) Have you ever surrendered your Indian passport? N
4.4) Have you ever applied for renunciation of Indian citizenship? N
5) Provide the following details if applicant has returned to India on Emergency Certificate.
5.1) Have you ever returned to India on Emergency Certificate (EC)? N
5.2) Have you ever been deported from any country? N
5.3) Have you ever been repatriated from any country back to India? N
Self Declaration
I declare:

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.
I understand:

That Ministry of External Affairs (MEA) (or its implementation partner agencies/stakeholders/third parties) may undertake required checks to confirm
the accuracy and authenticity of evidence I have provided and documents I have submitted with this application.
That the information I provide, including biometric data (if any), will be treated in confidence, but it may be disclosed to other government departments,
agencies, local authorities, foreign governments, and other implementation partner agencies/stakeholders/third parties to enable MEA or those bodies to
perform their duties.
That providing biometric information, if collected as part of an application, is confirmation of my consent to getting the biometric information checked to
verify identity.
That the Passport and related services applications may be handled by the Indian Embassies/Consulates/ Passport Office/other offices including outside of
the country in which I have applied and that this may involve the transfer of my application and supporting documents to and from the respective offices.
That my details may, in certain circumstances, be passed to Police, Intelligence and other Fraud Detection & Prevention agencies. I also understand that
such agencies may provide related information about me to MEA.

Place BRUNEI Signature/Left Hand Thumb Impression of Applicant

Date 07/10/2023 (If applicant is minor, either parent to sign)

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