5/19/25, 9:33 PM previewFormOrdinaryDetail
PASSPORT APPLICATION FORM
Ministry of External Affairs, Government of India
Service Required
Application Reference Number - 25-0051928059
Applying For - FRESH
Type of Application - NORMAL
Type of Passport Booklet - NORMAL
Applicant's Details
Applicant's Name - DIVYANSHU KUMAR
Date of Birth (DD/MM/YYYY) - 05/05/2006
Validity Required - NA
Place Of Birth (Village/Town/City) - BALLIA
District - BALLIA
State/UT - UTTAR PRADESH
Region/Country - INDIA
Gender - MALE
Marital Status - SINGLE
Citizenship of India by - BIRTH
Employment Type - GOVERNMENT
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 - N
category
Aadhaar Number - 803720255095
PAN - MKMPK4900R
Voter ID - NCW2866689
Family Details
Father Name - SWAMINATH VERMA
Mother Name - MEENA DEVI
Present Residential Address Details
Address - 007, CIVIL LINES FATAHA, MIRZAPUR, MIRZAPUR, UTTAR PRADESH
Pin - 231001
Police Station - KOTWALI NAGAR
Mobile/Tel No - 9151741310
E-mail - DIVYANSHU123VERM@[Link]
Emergency Contact Details
Name and Address - MEENA DEVI, CIVIL LINES FATAHA MIRZAPUR UTTAR PRADESH
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Mobile/Tel No - 7376907289
Email ID - DIVYANSHUVERMA2902@[Link]
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. Permanent Account Number Card issued by the Income-tax Department having the date of birth of the applicant
2. Bank/ Kisan/ Post Office Passbooks
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 - MIRZAPUR
Date - 19/05/2025
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