PASSPORT APPLICATION FORM
Ministry of External Affairs, Government of India
Service Required
Application Reference Number - 25-0060945207
Applying For - FRESH
Type of Application - NORMAL
Type of Passport Booklet - NORMAL
Applicant's Details
Applicant's Name - DEVENDER
Date of Birth (DD/MM/YYYY) - 12/06/1998
Validity Required - NA
Place Of Birth (Village/Town/City) - ALI BRAHMAN
District - PALWAL
State/UT - HARYANA
Region/Country - INDIA
Gender - MALE
Marital Status - MARRIED
Citizenship of India by - BIRTH
Employment Type - OTHERS
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 - Y
category
Visible Distinguishing Mark - CUT MARK NEAR TO LEFT EYE
Aadhaar Number - 899781726378
Family Details
Father Name - YAD RAM
Mother Name - SHANTI
Spouse's Name - PREETI RANI
Present Residential Address Details
Address - ALI BRAHMAN, PO ALI MEO HATHIN, PALWAL, HARYANA
Pin - 121106
Police Station - BAHIN
Mobile/Tel No - 8813909002 / 9991285309
E-mail - DEVENDERSEN298@GMAIL.COM
Emergency Contact Details
Name and Address - YAD RAM VILL ALI BRAHMAN PO ALI MEO HATHIN 121106
Mobile/Tel No - 8813062990
Email ID - NARESHSAN12345@GMAIL.COM
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Details of Previous/Current Diplomatic/Official Passport - N
Have you ever applied for passport, but not issued? - N
Other Details
Enclosures Details
1. Transfer or school leaving or matriculation certificate issued by the recognised school last attended or recognised
educational board having the date of birth of the applicant
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 - PALWAL
Date - 02/08/2025
