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PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 22-1011198729
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name GANESAN MAHALINGAM
Date of Birth (DD/MM/YYYY) 01/01/1985
Validity Required NA
Place of Birth (Village/Town/City) PARAPATHTHI MADURAI
District MADURAI RURAL
State/UT TAMIL NADU
Region/Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
Employment Type PRIVATE
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification 7TH PASS OR LESS
Are you eligible for Non-ECR category? N
Visible Distinguishing Mark A MOLE AT THE NECK
Aadhaar Number 222521208103
Family Details
Father's Name MAHALINGAM
Mother's Name MUTHUVEDACHI
Spouse's Name THILAGAVATHI
Present Residential Address Details
3/112 SOUTH STREET, PARAPPATHTHI, MADURAI RURAL, TAMIL
Address
NADU
PIN 625022
Police Station KOODAKOVIL
Mobile/Tel No. 9843319269
E-mail [email protected]
Emergency Contact Details
Name and Address THILAGAVATHI
Mobile/Tel No. 9655284240
Other Details
Enclosures
1.Aadhaar Card/E-Aadhaar
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 MADURAI
Date 29/09/2022

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