29/05/2025, 12:08 previewFormOrdinaryDetail
PASSPORT APPLICATION FORM
Ministry of External Affairs, Government of India
Service Required
Application Reference Number - 25-0052972686
Applying For - FRESH
Type of Application - NORMAL
Type of Passport Booklet - NORMAL
Applicant's Details
Applicant's Name - HARSH MISHRA
Date of Birth (DD/MM/YYYY) - 05/09/2004
Validity Required - NA
Place Of Birth
(Village/Town/City) - VARANASI
District - VARANASI
State/UT - UTTAR PRADESH
Region/Country - INDIA
Gender - MALE
Marital Status - SINGLE
Citizenship of India by - BIRTH
Employment Type - NOT EMPLOYED
Is either of your parent (in case - N
of minor)/spouse, a government
servant?
Educational Qualification
Are you eligible for Non-ECR -
- GRADUATE AND ABOVE
N
category
Visible Distinguishing Mark - NO
Aadhaar Number - 246793378784
PAN - HXFPM7893Q
Family Details
Father Name - ANAND KUMAR MISHRA
Mother Name - KUSUM MISHRA
Present Residential Address Details
Address - MANIYAREPUR, CHANDAWAK, JAUNPUR, UTTAR PRADESH
Pin - 222129
Police Station - CHANDWAK
Mobile/Tel No - 9569350789
E-mail - HARSHMISHRA2000KK@GMAIL.COM
Emergency Contact Details
Name and Address - ABHINEET CHAUBEY, LAMAHI PREMCHANDPURI, VARANASI
Mobile/Tel No - 7607019268
Email ID - ABHINEETCHAUBEY1226@GMAIL.COM
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
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29/05/2025, 12:08 previewFormOrdinaryDetail
Details of Previous/Current Diplomatic/Official Passport - N
Have you ever applied for passport, but not issued? - N
Other Details
Enclosures Details
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 - VARANASI
Date - 29/05/2025
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