7/15/24, 2:40 PM Application Form
PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 24-0012347864
Applying For REISSUE
If Re-issue, specify reason(s) VALIDITY EXPIRED WITHIN 3 YEARS/DUE TO EXPIRE.
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name SHRADDHA KRISHNAKANT JANI
Date of Birth (DD/MM/YYYY) 02/08/1958
Validity Required NA
Place of Birth (Village/Town/City) VASO
District KHEDA
State/UT GUJARAT
Region/Country INDIA
Gender FEMALE
Marital Status MARRIED
Citizenship of India by BIRTH
Employment Type HOME MAKER
Is either of your parent (in case of minor)/spouse,
N
a government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 890723393298
Family Details
Father's Name PRAHLADJIBHAI GORDHANBHAI VYAS
Mother's Name HEMLATA PRAHLADJIBHAI VYAS
Spouse's Name KRISHNAKANT THAKORLAL JANI
Present Residential Address Details
10/56, ANAND FLATS, NEAR VIJAY NAGAR, NARANPURA, AHMEDABAD,
Address
GUJARAT
PIN 380013
Police Station NARANPURA
Mobile/Tel No. 9426010067
E-mail KRISHNAKANTJANI50@GMAIL.COM
Permanent Residential Address
10/56, ANAND FLATS, NEAR VIJAY NAGAR, NARANPURA, AHMEDABAD,
Address
GUJARAT
PIN 380013
Police Station NARANPURA
Mobile/Tel No. 9426010067
Emergency Contact Details
KRISHNAKANT JANI, 10/56, ANAND FLATS, NEAR VIJAY NAAGR,
Name and Address
NARANPURA, AHMEDABAD 380013
Mobile/Tel No. 9426010067
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number M0192038
Date of Issue 21/07/2014
Date of Expiry 20/07/2024
Place of Issue AHMEDABAD
File Number AH2077781409214
Other Details
Enclosures
1.PAN Card issued by the Income Tax Department
2.Aadhaar Card (Address Proof)
Self Declaration
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7/15/24, 2:40 PM Application Form
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 AHMEDABAD
Date 15/07/2024
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