PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 25-0000155808
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name VISHAL KUMAR
Date of Birth (DD/MM/YYYY) 20/07/1996
Validity Required NA
Place of Birth (Village/Town/City) MEHARAMPUR
District BAGHPAT
State/UT UTTAR PRADESH
Region/Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN ITMPK7252K
Employment Type GOVERNMENT
Organisation name STATE GOVT UP
Is either of your parent (in case of minor)/spouse,
N
a government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark NA
Aadhaar Number 846904528078
Family Details
Father's Name JAGPAL
Mother's Name SANTRA
Spouse's Name RAVITA
Present Residential Address Details
VILL MEHARAMPUR POST KHATTA PRAHALDPUR, BAGHPAT, BAGHPAT,
Address
UTTAR PRADESH
PIN 250515
Police Station KHEKRA
Mobile/Tel No. 9536155289
E-mail VISHALGUJJAR9758@GMAIL.COM
Permanent Residential Address
VILL MEHARAMPUR POST KHATTA PRAHALDPUR, BAGHPAT, BAGHPAT,
Address
UTTAR PRADESH
PIN 250515
Police Station KHEKRA
Mobile/Tel No. 9536155289
Emergency Contact Details
JAGPAL SON SORAJ SINGH VILL MEHARAMPUR POST KHATTA PRAHALDPUR
Name and Address
TEH KHEKRA BAGHPAT UP
Mobile/Tel No. 9758288489
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.
Place MEHRAMPUR
Date 09/01/2025
