PASSPORT APPLICATION FORM
Ministry of External Affairs, Government of India
Service Required
Application Reference Number - 25-0054559092
Applying For - FRESH
Type of Application - NORMAL
Type of Passport Booklet - NORMAL
Applicant's Details
Applicant's Name - CHIRAG HARSUKHBHAI GHETIYA
Date of Birth (DD/MM/YYYY) - 16/07/1987
Validity Required - NA
Place Of Birth (Village/Town/City) - RAJKOT
District - RAJKOT
State/UT - GUJARAT
Region/Country - INDIA
Gender - MALE
Marital Status - MARRIED
Citizenship of India by - BIRTH
Employment Type - PRIVATE
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
Aadhaar Number - 414806619348
PAN - BQBPG4310B
Family Details
Father Name - HARSUKHBHAI KESHAVBHAI GHETIYA
Mother Name - BHARTIBEN HARSUKHBHAI GHETIYA
Spouse's Name - VARSHA CHIRAG BHAI GHETIYA
Present Residential Address Details
Address - 244,SARITA VIHAR SOCIETY 2,PUNA BOMBAY MARKET RD, PUNA, SURAT
CITY, GUJARAT
Pin - 395010
Police Station - PUNAGAM
Mobile/Tel No - 9924530108
E-mail - CHIRAGGHETIYA067@[Link]
Emergency Contact Details
Name and Address - HARSUKHBHAI GHETIYA
Mobile/Tel No - 9904979007
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. 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 - SURAT
Date - 11/06/2025
