4/28/24, 1:25 AM Application Form
PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 24-1005437103
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name ARPAN DE
Date of Birth (DD/MM/YYYY) 03/08/2000
Validity Required NA
Place of Birth (Village/Town/City) BALURGHAT
District HOWRAH
State/UT WEST BENGAL
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN HSGPD6077M
Voter Id ZTJ2537843
Employment Type STUDENT
Is either of your parent (in case of minor)/spouse,
Y
a government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 824344697426
Family Details
Father's Name ASHIM DE
Mother's Name PAMPA DE
Present Residential Address Details
PRAPTI HOUSING SOCIETY, 108 SUBINOY GHOSH SARANI, HOWRAH,
Address
HOWRAH, WEST BENGAL
PIN 711112
Police Station JAGACHA
Mobile/Tel No. 9007082960
E-mail ARPANDESP@GMAIL.COM
Permanent Residential Address
PRAPTI HOUSING SOCIETY, 108 SUBINOY GHOSH SARANI, HOWRAH,
Address
HOWRAH, WEST BENGAL
PIN 711112
Police Station JAGACHA
Mobile/Tel No. 9007082960
Emergency Contact Details
PAMPA DE, PRAPTI HOUSING SOCIETY, FLAT NO 4A, 108 SUBINOY GHOSH
Name and Address
SARANI, WARD NO 47, JAGACHHA, HOWRAH
Mobile/Tel No. 9875585139
Other Details
Enclosures
1.Election Photo Identity Card (EPIC) issued by the Election Commission of India
2.Electors Photo Identity Card (EPIC)
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.
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4/28/24, 1:25 AM Application Form
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 HOWRAH
Date 28/04/2024
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