Scribd
Upload
9 views2 pages

Application Form

The document is a passport application form for Krishna Nand Rajbhar, applying for a fresh normal passport. The applicant is a male born on July 16, 2002, in Ajiipur, Uttar Pradesh, and has provided personal, family, and contact details along with necessary enclosures. The applicant affirms the authenticity of the information provided and acknowledges the legal implications of false declarations.

Uploaded by

satishonline2022
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
9 views2 pages

Application Form

The document is a passport application form for Krishna Nand Rajbhar, applying for a fresh normal passport. The applicant is a male born on July 16, 2002, in Ajiipur, Uttar Pradesh, and has provided personal, family, and contact details along with necessary enclosures. The applicant affirms the authenticity of the information provided and acknowledges the legal implications of false declarations.

Uploaded by

satishonline2022
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
You are on page 1/ 2

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 25-0003120208
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name KRISHNA NAND RAJBHAR
Date of Birth (DD/MM/YYYY) 16/07/2002
Validity Required NA
Place of Birth (Village/Town/City) AJIJPUR
District GHAZIPUR
State/UT UTTAR PRADESH
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN FFCPR7239A
Employment Type PRIVATE
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark A CUT MARK ON THE HEAD
Aadhaar Number 206939615959
Family Details
Father's Name ARVIND RAJBHAR
Mother's Name PUSHPA DEVI
Legal Guardian's Name ARVIND RAJBHAR
Present Residential Address Details
VILLAGE AJIJPUR POST BARACHAWAR, AJIJPUR, GHAZIPUR, UTTAR
Address
PRADESH
PIN 233229
Police Station BADESAR
Mobile/Tel No. 9696506908
E-mail KRISHNANANDRAJBHAR66@GMAIL.COM
Emergency Contact Details
Name and Address KRISHNA NAND RAJBHAR AND AJIJAPUR
Mobile/Tel No. 9696506908
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 AJIJPUR
Date 24/02/2025

You might also like