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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 - 25-0061158228 Please paste your
Number unsigned recent
Applying For - REISSUE color photograph
of size 4.5cm *
If Re-issue, specify - CHANGE IN EXISTING PERSONAL PARTICULARS 3.5cm.
reason(s)
If change in existing - GIVEN NAME , SURNAME , DELETE ECR , OTHER
personal particulars,
specify
If other, specify - MOTHER'S NAME
Type of Application - NORMAL
Type of Passport - NORMAL Signature/Left Hand Thumb
Booklet Impression of Illiterate Applicant and
Minors who cannot sign.
Applicant Details
Applicant's Name - MD AAMIR
Date of Birth - 01/01/1995
(DD/MM/YYYY)
Validity Required - NA
Place Of Birth - SAMASTIPUR
(Village/Town/City)
District - SAMASTIPUR
State/UT - BIHAR
Region/Country - INDIA
Gender - MALE
Marital Status - SINGLE
Citizenship of India by - BIRTH
PAN - EQAPA3773A
Employment Type - OTHERS
Is either of your parent - N
(in case of
minor)/spouse, a
government servant?
Educational - 10TH PASS AND ABOVE
Qualification
Are you eligible for - Y
Non-ECR category
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Visible Distinguishing - BLACK MOLE ON THE NOSE
Mark
Aadhaar Number - 383348925842
Family Details
Father Name - MD SHAKIL
Mother Name - AFSANA KHATUN
Legal Guardian Name - MD SHAKIL
Present Residential Address Details:
Address - RAHIMPUR RUDAULI, WARD NO-42, PO-HARPUR AILOTH, SAMASTIPUR,
BIHAR
Pin - 848101
Police Station - MUFASSIL
Mobile/Tel No - 7360822686
Email - MDAMIR101221@GMAIL.COM
Permanent Residential Address Details
Address - RAHIMPUR RUDAULI, WARD NO-42, PO-HARPUR AILOTH, SAMASTIPUR,
BIHAR
Pin - 848101
Police Station - MUFASSIL
Mobile/Tel No - 7360822686
EmergencyContactDetails:
Name and Address - NAME-MD DILSHAD,ADDRESS-WARD NO-42 RAHIMPUR RUDAULI,PO-
HARPUR AILOTH,DIST-SAMASTIPUR,PIN-848101,BIHAR,IND
Mobile/Tel No. - 6299101221
E-mail - MDDILSHADSPJ1999@GMAIL.COM
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number - C4440150
Date of Issue - 27/11/2024
Date of Expiry - 26/11/2034
Place of Issue - PATNA
File Number - PA27C4046211224
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) -
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DD Expiry Date (dd/mm/yyyy) -
Bank Name -
Branch -
Enclosures:
1. Aadhaar Card (Address Proof)2. 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.
Place - SAMASTIPUR
Signature/Left Hand Thumb Impression
of Applicant (If applicant is minor, either
Date - 04/08/2025
parent to sign)
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