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Application Form

The document is a passport application form for Yash Kumar Mittal, applying for a fresh normal passport. It includes personal details such as date of birth, address, and family information, as well as a self-declaration affirming the accuracy of the provided information. The application is submitted to the Government of India, Ministry of External Affairs, with a reference number 24-0001907456.

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yash
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17 views2 pages

Application Form

The document is a passport application form for Yash Kumar Mittal, applying for a fresh normal passport. It includes personal details such as date of birth, address, and family information, as well as a self-declaration affirming the accuracy of the provided information. The application is submitted to the Government of India, Ministry of External Affairs, with a reference number 24-0001907456.

Uploaded by

yash
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-0001907456
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name YASH KUMAR MITTAL
Date of Birth (DD/MM/YYYY) 14/08/1996
Validity Required NA
Place of Birth (Village/Town/City) MODINAGAR
District GHAZIABAD
State/UT UTTAR PRADESH
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
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? Y
Aadhaar Number 302525933322
Family Details
Father's Name SUNIL KUMAR MITTAL
Mother's Name KAVITA MITTAL
Present Residential Address Details
HOUSE NO 135 , FAFRANA ROAD BHRAMPURI STREET NO4, MODINAGAR,
Address
GHAZIABAD, UTTAR PRADESH
PIN 201204
Police Station MODINAGAR
Mobile/Tel No. 9520575797
E-mail YASHMIT6@GMAIL.COM
Permanent Residential Address
HOUSE NO 135 , FAFRANA ROAD BHRAMPURI STREET NO4, MODINAGAR,
Address
GHAZIABAD, UTTAR PRADESH
PIN 201204
Police Station MODINAGAR
Mobile/Tel No. 9520575797
Emergency Contact Details
KAVITA MITTAL HOUSE NO 135 FAFRANA ROAD BHRAMPURI STREET NO 4
Name and Address
MODINAGAR
Mobile/Tel No. 7983727459
Other Details
Enclosures
1.PAN Card issued by the Income Tax Department
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 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 MODINAGAR
Date 30/01/2024
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