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File Number (For Office Use Only)
Ministry of External Affairs, Government of India
PASSPORT APPLICATION FORM
Please read the Passport Instruction Booklet carefully before filling the form. Fill this form in CAPITAL LETTERS using
blue/black ink ball point pen only. Furnishing of incorrect information/ suppression of information would lead to
rejection of the application and would attract penal provisions as prescribed under the Passports Act, 1967. Please
produce your original documents at the time of submission of the form.
Service Required
Application Reference - 25-0055047552 Please paste your
Number unsigned recent
Applying For - FRESH color photograph
of size 4.5cm *
Type of Application - NORMAL 3.5cm.
Type of Passport - NORMAL
Booklet
Applicant Details
Applicant's Name - RUPENDRA PRAJAPATI
Date of Birth - 12/08/2000
(DD/MM/YYYY) Signature/Left Hand Thumb
Validity Required - NA Impression of Illiterate Applicant and
Minors who cannot sign.
Place Of Birth - HARDA
(Village/Town/City)
District - HARDA
State/UT - MADHYA PRADESH
Region/Country - INDIA
Gender - MALE
Marital Status - SINGLE
Citizenship of India by - BIRTH
PAN - GBEPP3768K
Employment Type - STUDENT
Is either of your parent - N
(in case of
minor)/spouse, a
government servant?
Educational - GRADUATE AND ABOVE
Qualification
Are you eligible for - Y
Non-ECR category
Visible Distinguishing - CUT ON RIGHT HAND THUMB
Mark
Aadhaar Number - 605855872532
Family Details
Father Name - RAMCHANDRA PRAJAPATI
Mother Name - VINDHYA PRAJAPATI
Present Residential Address Details:
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6/15/25, 11:03 AM ViewPrintApplicationReceipt
Address - PRAJAPATI HOUSE, STREET NO.10, JOSHI COLONY, HARDA, HARDA,
MADHYA PRADESH
Pin - 461331
Police Station - HARDA
Mobile/Tel No - 8839408110
Email - RUPENDRAHARDA@GMAIL.COM
Permanent Residential Address Details
Address - PRAJAPATI HOUSE, STREET NO.10, JOSHI COLONY, HARDA, HARDA,
MADHYA PRADESH
Pin - 461331
Police Station - HARDA
Mobile/Tel No - 8839408110
EmergencyContactDetails:
Name and Address - HEMRAJ PRAJAPATI- PRAJAPATI HOUSE, STREET NO 10, JOSHI COLONY
HARDA- MP 461331
Mobile/Tel No. - 8770782983
E-mail - CHOTUPRAJPATI364@GMAIL.COM
Previous Passport
Other Details
Fee Details (Not to be filled by applicants submitting the application at Passport Seva
Kendra/Passport Office)
Fee amount in (Rs) -
If paid by Demand Draft(DD), provide the following details
DD Issue Date (dd/mm/yyyy) -
DD Expiry Date (dd/mm/yyyy) -
Bank Name -
Branch -
Enclosures:
1. Income Tax Identity (PAN) Cards2. Permanent Account Number Card issued by the Income-tax Department having
the date of birth of the applicant
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.
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6/15/25, 11:03 AM ViewPrintApplicationReceipt
Place - INDORE
Signature/Left Hand Thumb Impression
of Applicant (If applicant is minor,
Date - 15/06/2025
either parent to sign)
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