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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 - 25-0061544379 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 - VIDYASAGAR PANDEY
Date of Birth - 08/07/1979
(DD/MM/YYYY) Signature/Left Hand Thumb
Validity Required - NA Impression of Illiterate Applicant and
Minors who cannot sign.
Place Of Birth - PRAYAGRAJ
(Village/Town/City)
District - PRAYAGRAJ
State/UT - UTTAR PRADESH
Region/Country - INDIA
Gender - MALE
Marital Status - MARRIED
Citizenship of India by - BIRTH
PAN - ANGPV2223F
Employment Type - PRIVATE
Is either of your parent - N
(in case of
minor)/spouse, a
government servant?
Educational - BETWEEN 8TH AND 9TH STANDARD
Qualification
Are you eligible for - N
Non-ECR category
Aadhaar Number - 351996527277
Family Details
Father Name - KANHAIYA LAL PANDEY
Mother Name - SHIV SHAWARI DEVI
Spouse's Name - MAMATA DEVI
Present Residential Address Details:
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Address - AKBARPUR SARAIDEENA BENIYAPUR SORAON, PRAYAGRAJ, PRAYAGRAJ,
UTTAR PRADESH
Pin - 212502
Police Station - SORAON
Mobile/Tel No - 9006256056
Email - AKHILESHPANDEY9470@GMAIL.COM
Permanent Residential Address Details
Address - AKBARPUR SARAIDEENA BENIYAPUR SORAON, PRAYAGRAJ, PRAYAGRAJ,
UTTAR PRADESH
Pin - 212502
Police Station - SORAON
Mobile/Tel No - 9006256056
EmergencyContactDetails:
Name and Address - NILESH PANDEY AKBARPUR SARAIDEENA SORAON PRAYAGRAJ
Mobile/Tel No. - 9511441165
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. 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.
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08/08/2025, 10:59 ViewPrintApplicationReceipt
Place - DIST PRAYAGRAJ
Signature/Left Hand Thumb Impression
of Applicant (If applicant is minor,
Date - 08/08/2025
either parent to sign)
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