4/4/25, 6:38 AM Application Form
PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 25-0005040310
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name ANIL KUMAR SINGH
Date of Birth (DD/MM/YYYY) 01/01/1964
Validity Required NA
Place of Birth (Village/Town/City) CHANDAULI
District CHANDAULI
State/UT UTTAR PRADESH
Region/Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN BLYPS3976F
Employment Type SELF EMPLOYED
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification 7TH PASS OR LESS
Are you eligible for Non-ECR category? Y
Aadhaar Number 785952024353
Family Details
Father's Name TARKESHWAR SINGH
Mother's Name GYANTI DEVI
Spouse's Name POONAM SINGH
Present Residential Address Details
Address JAMUNIPUR, JAMUNIPUR, CHANDAULI, UTTAR PRADESH
PIN 232104
Police Station CHANDAULI
Mobile/Tel No. 9918342600
E-mail VNSDSZONE3@GMAIL.COM
Permanent Residential Address
Address JAMUNIPUR, JAMUNIPUR, CHANDAULI, UTTAR PRADESH
PIN 232104
Police Station CHANDAULI
Mobile/Tel No. 9918342600
Emergency Contact Details
PRAVESH SINGH , JAMUNIPUR , CHANDAULI, UTTAR PRADESH ,
Name and Address
232104
Mobile/Tel No. 8874007373
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 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 CHANDAULI
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4/4/25, 6:38 AM Application Form
Date 04/04/2025
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