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PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 23-0017734790
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name CHAKRAVATI RUPESH LOKHANDE
Alias Name1 SUSHANT RUPESH LOKHANDE
Date of Birth (DD/MM/YYYY) 13/09/2000
Validity Required NA
Place of Birth (Village/Town/City) KOLHI
District WARDHA
State/UT MAHARASHTRA
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN BEBPL8858R
Employment Type PRIVATE
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
Aadhaar Number 254157570623
Family Details
Father's Name RUPESH VISHWANATH LOKHANDE
Mother's Name SITA RUPESH LOKHANDE
Present Residential Address Details
KOLHI(GAVHA) TA.HINGANGHT DIST.WARDHA, KOLHI GAVHA, WARDHA,
Address
MAHARASHTRA
PIN 442301
Police Station HINGANGHAT
Mobile/Tel No. 9860611647
E-mail LOKHANDECHAKRAVARTI@GMAIL.COM
Permanent Residential Address
KOLHI(GAVHA) TA.HINGANGHT DIST.WARDHA, KOLHI GAVHA, WARDHA,
Address
MAHARASHTRA
PIN 442301
Police Station HINGANGHAT
Mobile/Tel No. 9860611647
Emergency Contact Details
Name and Address CHAKRAVATI RUPESH LOKHANDE
Mobile/Tel No. 9860611647
E-mail LOKHANDECHAKRAVARTI@GMAIL.COM
Other Details
Enclosures
1.Aadhaar Card/E-Aadhaar
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
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19/09/2023, 16:25 Application Form
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 KOLHI GAVHA
Date 19/09/2023
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