08/03/2025, 20:25 Application Form
PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 25-0003769160
Applying For FRESH
Type of Application TATKAAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name PRATIT PRATINAV DEKA
Date of Birth (DD/MM/YYYY) 16/09/2005
Validity Required NA
Place of Birth (Village/Town/City) GUWAHATI
District KAMRUP (METROPOLITAN)
State/UT ASSAM
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN JEQPD7611H
Employment Type STUDENT
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? Y
Visible Distinguishing Mark MOLE ON RIGHT HAND
Aadhaar Number 572247329832
Family Details
Father's Name MUKUL DEKA
Mother's Name HIMAKSHI DEKA
Present Residential Address Details
ZOO NARENGI ROAD MONALISA PATH, GUWAHATI, KAMRUP
Address
(METROPOLITAN), ASSAM
PIN 781024
Police Station GEETANAGAR
Mobile/Tel No. 9395786977
E-mail PRATITPRATINAVDEKA@GMAIL.COM
Permanent Residential Address
ZOO NARENGI ROAD MONALISA PATH, GUWAHATI, KAMRUP
Address
(METROPOLITAN), ASSAM
PIN 781024
Police Station GEETANAGAR
Mobile/Tel No. 9395786977
Emergency Contact Details
Name and Address MUKUL DEKA
Mobile/Tel No. 9435011088
Other Details
Enclosures
1.Permanent Account Number Card issued by the Income-tax Department having the date of birth of the applicant
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
material information in this regard. I further affirm that the enclosures and documentary proof submitted in support of my application for an
https://portal1.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 1/2
08/03/2025, 20:25 Application Form
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 GUWAHATI
Date 08/03/2025
https://portal1.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 2/2
