26/11/2024, 23:07 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-0019712914
Applying For REISSUE
If Re-issue, specify reason(s) VALIDITY EXPIRED WITHIN 3 YEARS/DUE TO EXPIRE.
Type of Application TATKAAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name AAFAQUE HAIDAR
Date of Birth (DD/MM/YYYY) 02/06/1986
Validity Required NA
Place of Birth (Village/Town/City) SANKHANI
District BULANDSHAHR
State/UT UTTAR PRADESH
Region/Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN AKYPH3558C
Employment Type NOT EMPLOYED
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? N
Aadhaar Number 369662859555
Family Details
Father's Name KAZIM ALI
Mother's Name BEGUM FATIMA
Spouse's Name SAISTA MIRZA
Present Residential Address Details
Address 626 SANKHNI, BULANDSHAHR, BULANDSHAHR, UTTAR PRADESH
PIN 202394
Police Station JAHANGIRABAD
Mobile/Tel No. 9119764609
E-mail [email protected]
Permanent Residential Address
Address 626 SANKHNI, BULANDSHAHR, BULANDSHAHR, UTTAR PRADESH
PIN 202394
Police Station JAHANGIRABAD
Mobile/Tel No. 9119764609
Emergency Contact Details
Name and Address SAISTA MIRZA
Mobile/Tel No. 7088609443
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number L7373626
Date of Issue 27/02/2014
Date of Expiry 26/02/2024
Place of Issue SANKHNI
File Number GZ1067408405413
Other Details
Enclosures
1.PAN Card issued by the Income Tax Department
2.Aadhaar Card (Address Proof)
3.Affidavit stating how and where the Passport got lost/ damaged as per Annexure F
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
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26/11/2024, 23:07 Application Form
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 BULANDSHAHR
Date 26/11/2024

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