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This document is a passport application form for Kiran Kumari, a female student from Samba, Jammu and Kashmir, applying for a fresh normal passport. The application includes personal details, family information, residential address, emergency contact, and a self-declaration affirming the authenticity of the information provided. The application is submitted to the Ministry of External Affairs, Government of India, on January 27, 2025.

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Sham Sunder
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18 views2 pages

previewFormOrdinaryDetail 2kiran

This document is a passport application form for Kiran Kumari, a female student from Samba, Jammu and Kashmir, applying for a fresh normal passport. The application includes personal details, family information, residential address, emergency contact, and a self-declaration affirming the authenticity of the information provided. The application is submitted to the Ministry of External Affairs, Government of India, on January 27, 2025.

Uploaded by

Sham Sunder
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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1/27/25, 2:36 PM previewFormOrdinaryDetail

PASSPORT APPLICATION FORM


Ministry of External Affairs, Government of India

Service Required
Application Reference Number - 25-0049076868
Applying For - FRESH
Type of Application - NORMAL
Type of Passport Booklet - NORMAL

Applicant's Details
Applicant's Name - KIRAN KUMARI
Date of Birth (DD/MM/YYYY) - 19/01/2002
Validity Required - NA
Place Of Birth (Village/Town/City) - SAMBA
District - SAMBA
State/UT - JAMMU AND KASHMIR
Region/Country - INDIA
Gender - FEMALE
Marital Status - SINGLE
Citizenship of India by - BIRTH
Employment Type - STUDENT
Is either of your parent (in case of - N
minor)/spouse, a government
servant?
Educational Qualification - 10TH PASS AND ABOVE
Are you eligible for Non-ECR - Y
category
Aadhaar Number - 535954603768
PAN - JUVPK2377C

Family Details
Father Name - RAJ KUMAR
Mother Name - BIMLA

Present Residential Address Details


Address - LANGTHA NH44, LANGTHA SAMBA, SAMBA, JAMMU AND KASHMIR
Pin - 184121
Police Station - SAMBA
Mobile/Tel No - 6006624997
E-mail - KIRANRAJBIMLA0000@GMAIL.COM

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Emergency Contact Details


Name and Address - AKASH RAJ R/O LANGTHA SAMBA
Mobile/Tel No - 7006467294

Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport

Details of Previous/Current Diplomatic/Official Passport - N

Have you ever applied for passport, but not issued? - N

Other Details
Enclosures Details
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 - SAMBA

Date - 27/01/2025

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