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AMIT

This document is a passport application form for Mintu Gosvami, applying for a fresh normal passport. The applicant is a 44-year-old male from Simrahi, Bihar, with a 7th-grade education and various personal details provided. The application includes a self-declaration affirming the authenticity of the information and enclosures submitted.

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dsolutionhub459
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20 views1 page

AMIT

This document is a passport application form for Mintu Gosvami, applying for a fresh normal passport. The applicant is a 44-year-old male from Simrahi, Bihar, with a 7th-grade education and various personal details provided. The application includes a self-declaration affirming the authenticity of the information and enclosures submitted.

Uploaded by

dsolutionhub459
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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PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 23-0007713646
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name MINTU GOSVAMI
Date of Birth (DD/MM/YYYY) 01/01/1979
Validity Required NA
Place of Birth (Village/Town/City) SIMRAHI
District SUPAUL
State/UT BIHAR
Region/Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
Employment Type OTHERS
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification 7TH PASS OR LESS
Are you eligible for Non-ECR category? N
Visible Distinguishing Mark EXTRA MASS ON NECK
Aadhaar Number 565181766990
Family Details
Father's Name SAHDEV GOSVAMI
Mother's Name KAILI DEVI
Spouse's Name RANI DEVI
Present Residential Address Details
S/O SAHDEV GOSVAMI, WARD NO-14, SIMRAHI, SIMRAHI, SUPAUL,
Address
BIHAR
PIN 852111
Police Station RAGHUR
Mobile/Tel No. 6205872529
E-mail DSOLUTIONHUB459@GAMIL.COM
Emergency Contact Details
Name and Address AMIT KUMAR
Mobile/Tel No. 9801628584
Other Details
Enclosures
1.Aadhaar Card/E-Aadhaar
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 PATNA
Date 27/04/2023

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