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PASSPORT APPLICATION FORM
Ministr y of External Affairs, Government of India
Service Required
Application Reference Number - 25-1058461499
Applying For - FRESH
Type of Application - NORMAL
Type of Passport Booklet - NORMAL
Applicant's Details
Applicant's Name - SAI KISHORE R
Date of Birth (DD/MM/YYYY) - 23/11/2004
Validity Required - NA
Place Of Birth (Village/Town/City) - ENATHUR
District - KANCHIPURAM
State/UT - TAMIL NADU
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 - 10TH PASS AND ABOVE
Are you eligible for Non-ECR - Y
category
Visible Distinguishing Mark - MOLE IN LEFT UPPER CHEST
Aadhaar Number - 231386806596
PAN - QNCPS9303D
Family Details
Father Name - RAGHU D
Mother Name - GOMATHI K
Present Residential Address Details
Address - 6/376 MMDA 37TH STREET, MADURAVOYAL, CHENNAI, TAMIL NADU
Pin - 600095
Police Station - T-4 MADHURAVOYAL
Mobile/Tel No - 7200320940
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E-mail - SSAIKISHOREE07@GMAIL.COM
Emergency Contact Details
Name and Address - RAGHU 6/376 MMDA 37TH STREET MADURAVOYAL,CHENNAI
Mobile/Tel No - 9940409288
Email ID - GOMATHI_RAGHU@YAHOO.CO.IN
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. 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)
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 - CHENNAI
Date - 06/08/2025
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