6/15/2014 Application Form

https://portal1.passportindia.gov.in/AppOnlineProject/secure/openPdfForApplReciept 1/2
Passport Application
Government of India, Ministry of External Affairs
Online Application Receipt
ATM facility available at PSK
for all Bank Cards
Applicant Details:
Application Reference No. 14-0006180172
Batch 5
Sequence No. 1
Reporting Time 10:15 AM
Service Type FRESH
Type of Application Normal
Application Submitted Date 12/06/2014
Date of Birth 21/05/2013
Gender MALE
Employment Type NOT EMPLOYED
Marital Status SINGLE
Place of Birth VAISHALI,GHAZIABAD,UTTAR
PRADESH
Given Name ROSHAN SINGH
Surname BHATIA
Father's Name GURPREET SINGH BHATIA
Mother's Name CHANPREET KAUR BHATIA
Present Address 1401, CORAL HEIGHTS, RAMPRASTHA GREENS, VAISHALI, GHAZIABAD, 201010, UTTAR
PRADESH, INDIA
Applicants References:
First Reference Details KULVINDER SINGH BHATIA 1006, CORAL HEIGHTS, RAMPRASTHA GREENS, VAISHALI, SEC-7,
GHAZIABAD, 9811515544
Second Reference Details RITIKA ARORA, 0904,CORAL HEIGHTS, RAMPRASTHA GREENS, VAISHALI, SEC-7, GHAZIABAD,
9810699847

Payment Details:
#
Total Fee (Rs.) 1000.00
Paid Fee (Rs.) 1000.00
Date and Time 13/06/2014 07:02 PM
Transaction Id CP07252323

Appointment Details:
PSK Location
Ghaziabad,
PASSPORT SEVA KENDRA, BLOCK-A
GROUND FLOOR, PACIFIC BUSINESS
PARK, PLOT NO 37/1, SITE IV,
SAHIBABAD INDUSTRIAL AREA,
GHAZIABAD - 201010
Date and Time of
Appointment
30/07/2014 & 10:30 AM
Appointment Id 100005200608714
Reporting Time 10:15 AM



Note:
Applicant should reach the Passport Seva Kendra by the reporting time mentioned above for pre-checking of documents
to avoid any hassles in issuance of token.
Applicant should bring all the originals and one set of photo copy, photo copies should be self attested by the applicant. In
case of minor either of the parents has to sign on all photo copies.
One accompanying person from the family will be allowed along with Senior Citizens, Physically Challenged, Illiterate and
Minor applicants only.
Applicant will not be issued token at Passport Seva Kendra, if they report after scheduled appointment time.
Minor applicants below 4 years of age need to carry a recent coloured passport size (4.5 x 3.5 cm) photograph with a white
background while visiting Passport Seva Kendra. Other applicants need not carry any photograph as photograph will be
captured at the Passport Seva Kendra.
Carrying of corrosive substances or explosives, arms or any sharp objects which may cause physical harm or violence are
prohibited inside the PSK. Electronic item such as camera is prohibited inside the PSK.
Balance fee (if applicable) after editing the submitted form will be payable in cash at the Passport Seva Kendra.
# Details as per the Payment Date. Payment once made for availing passport services will not be refunded.
6/15/2014 Application Form
https://portal1.passportindia.gov.in/AppOnlineProject/secure/openPdfForApplReciept 2/2