PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 24-1000827847
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name SURYA NARAYANAN
Date of Birth (DD/MM/YYYY) 01/12/2003
Validity Required NA
Place of Birth (Village/Town/City) TOWN
District SALEM
State/UT TAMIL NADU
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN FQUPR3326H
Employment Type STUDENT
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? Y
Visible Distinguishing Mark A MOLE OF RIGHT SIDE HEAD ABOVE
Aadhaar Number 789042236300
Family Details
Father's Name RAJARAM
Mother's Name PADMAVATHI
Present Residential Address Details
333/1 LINE ROAD 1ST WEST STREET GUGAI SALEM, TOWN, SALEM, TAMIL
Address
NADU
PIN 636006
Police Station SHEVAPET
Mobile/Tel No. 8925142636
E-mail GATESSURYA71@GMAIL.COM
Permanent Residential Address
333/1 LINE ROAD 1ST WEST STREET GUGAI SALEM, TOWN, SALEM, TAMIL
Address
NADU
PIN 636006
Police Station SHEVAPET
Mobile/Tel No. 8925142636
Emergency Contact Details
Name and Address PRAKASH 333/1 LINE ROAD 1ST WEST STREET GUGAI SALEM 6
Mobile/Tel No. 8825965598
E-mail PS88259655@GMAIL.COM
Other Details
Enclosures
1.Election Photo Identity Card (EPIC) issued by the Election Commission of 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 SALEM
Date 18/01/2024
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