9/18/22, 2:57 PM Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 22-0015895916
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name KRITI
Date of Birth (DD/MM/YYYY) 11/09/1993
Validity Required NA
Place of Birth (Village/Town/City) NEW DELHI
District WEST DELHI
State/UT DELHI
Region/Country INDIA
Gender FEMALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN FLWPK2256N
Voter Id NGQ1468386
Employment Type PSU
Organisation name PUNJAB NATIONAL BANK
Is either of your parent (in case of minor)/spouse, a government servant? Y
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 308584848760
Family Details
Father's Name UDHAM CHAND BAGHI
Mother's Name SUMAN LATA
Present Residential Address Details
Address J 84 THIRD FLOOR VIKASPURI, VIKASPURI, WEST DELHI, DELHI
PIN 110018
Police Station VIKAS PURI
Mobile/Tel No. 9643499017
E-mail [email protected]
Emergency Contact Details
Name and Address SUMAN LATA J 84 THIRD FLOOR VIKASPURI NEW DELHI 110018
Mobile/Tel No. 9871534441
E-mail [email protected]

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9/18/22, 2:57 PM Application Form

Other Details
Enclosures
1.Aadhaar Card/E-Aadhaar
2.Bank/ Kisan/ Post Office Passbooks
3.Identity Certificate in original as per Annexure A
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 NEW DELHI
Date 18/09/2022

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