6/14/24, 2:53 PM Application Form
PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 24-0010447416
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name KAMINI ARUNKUMAR ACHARYA
Date of Birth (DD/MM/YYYY) 01/02/1970
Validity Required NA
Place of Birth (Village/Town/City) SIDHPUR
District GANDHINAGAR
State/UT GUJARAT
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
Voter Id LPZ8168775
Employment Type GOVERNMENT
Organisation name CIVIL HOSPITAL GANDHINAGAR
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Family Details
Father's Name ARUNKUMAR ACHARYA
Mother's Name JYOTIBEN ACHARYA
Present Residential Address Details
D/103,FIRST FLOOR,PARSHWANATH ATLANTIS PARK, GANDHINAGAR,
Address
GANDHINAGAR, GUJARAT
PIN 382424
Police Station ADALAJ
Mobile/Tel No. 8238325592
E-mail MODI0516@GMAIL.COM
Permanent Residential Address
D/103,FIRST FLOOR,PARSHWANATH ATLANTIS PARK, GANDHINAGAR,
Address
GANDHINAGAR, GUJARAT
PIN 382424
Police Station ADALAJ
Mobile/Tel No. 8238325592
Emergency Contact Details
Name and Address DIMPAL BHIMANI
Mobile/Tel No. 9104370346
Other Details
Enclosures
1.Transfer/School leaving/Matriculation Certificate issued by the school last attended/recognized educational board
2.Aadhaar Card (Address Proof)
3.No Objection Certificate (NOC) as per Annexure G
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.
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6/14/24, 2:53 PM Application Form
Place SIDHPUR
Date 14/06/2024
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