17/04/2025, 21:46 Application Form
PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 25-1004172433
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name ABHINAV MANJUNATH BHANDARE
Date of Birth (DD/MM/YYYY) 10/11/2014
Validity Required NA
Place of Birth (Village/Town/City) KAIJ
District BEED
State/UT MAHARASHTRA
Region/Country INDIA
Gender MALE
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 7TH PASS OR LESS
Are you eligible for Non-ECR category? Y
Aadhaar Number 772120101607
Family Details
Father's Name MANJUNATH NANJUNDARAO BHANDARE
Mother's Name SARITA MANJUNATH BHANDARE
Mother/Legal guardian's File/Passport Number T6523688
Present Residential Address Details
FLAT NO 204, 2ND FLOOR, CHAITANYA PARADISE APT, KODICHIKKANAHALLI,
Address
BENGALURU, KARNATAKA
PIN 560076
Police Station BOMMANAHALLI
Mobile/Tel No. 9035904821
E-mail SARITAMB553@GMAIL.COM
Permanent Residential Address
FLAT NO 204, 2ND FLOOR, CHAITANYA PARADISE APT, KODICHIKKANAHALLI,
Address
BENGALURU, KARNATAKA
PIN 560076
Police Station BOMMANAHALLI
Mobile/Tel No. 9035904821
Emergency Contact Details
MANJUNATH N B, FLAT NO 204, 2ND FLOOR, CHAITANYA PARADISE
Name and Address
APARTMENT, KODICHIKKANAHALLI, BENGALURU-560076
Mobile/Tel No. 9620012627
Other Details
Enclosures
1.Birth certificate issued by the Registrar of Births and Deaths or the Municipal Corporation or any other authority, empowered under
the Registration of Births and Deaths Act, 1969 (18 of 1969)
2.Aadhaar Card (Address Proof)
3.A declaration affirming the particulars furnished in the application about the minor as per Annexure D
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.
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17/04/2025, 21:46 Application Form
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 BENGALURU
Date 17/04/2025
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