Professional Documents
Culture Documents
1. Service Required
1.1 Applying for
Fresh Passport
Re-issue of Passport
Exhaustion of Pages
Lost Passport
Damaged Passport
Signature
Given Name
Surname
Date of Birth
Spouse Name
Address
Delete ECR
2 0
S A
V D H A M
K R
P A
R E G E N C Y
I M B O D H
S H
N D O R E
Normal
Tatkaal
36 Pages
60 Pages
10 Years
Up to age 18
2. Applicant Details
2.1 Applicant's Given Name (Given Name means First name followed by Middle name (If any))(Initials not allowed)
R
T U N E S H
Surname
K U M A
Yes
No
Yes
No
1 -
0 7
1 9 7 9
P R A D E
S H
Country (If born abroad) If born before 15/08/1947 in a place now in Pakistan or Bangladesh, write
"Undivided India"
2.6 Gender
Male
Female
Transgender
Single
Married
Divorced
Widow/ Widower
Birth
Descent
Registration/ Naturalization
A T
P K
Separated
1 G
Government
Statutory Body
Self Employed
Private
Homemaker
Not Employed
Retired-Private Service
Student
Others
Owners, Partners & Directors of companies which are members of CII, FICCI & ASSOCHAM
N D O R
2.13 Is either of your parent (in case of minor)/ spouse, a government servant?
Yes
No
O N
Yes
T O M A C H
Page 2 of 6
3.1 Father's Given Name (Given Name means First name followed by Middle name (If any)) (Initials not allowed)
H
R A
L A
Surname
M A U R Y A
3.2 Mother's Given Name (Given Name means First name followed by Middle name (If any)) (Initials not allowed)
P U S
H P A
Surname
R A N
3.3 Legal Guardian's Given Name (If applicable) (Initials not allowed)
Surname
3.4 Spouse's Given Name (Given Name means First name followed by Middle name (If any)) (Initials not allowed)
A
Surname
G A H L O T
S A
P A
E G E N C Y
V D H A M
N D O R
District
I
N D O R
Police Station
B H A W A R
K U A N
State/ UT
M A D H Y A
P R A D E
S H
PIN
1 7
Mobile Number
1 0
Telephone Number
1 2
1 8
h @
E-mail ID
u n e
Yes
Name and Address (Mention address only if different from present residential address)
D R
K U M A R
R A H A N A
N E W
B A
U T
P R A D E
L A H A
N D R A
B A D
P U R
T
Mobile Number
9
Telephone Number
u @ g m a
E-mail ID
m
o m
Page 4 of 6
M 5
A M O D
7
A G A R
U M A R
N E A R
N A V
N D O R
N E
Mobile Number
9
K A R
G 2
E T
B A
G A R D E N
G D R
E A
D Y A N
Telephone Number
7
D R
A N A N D
N C Y
P A R
V D H A M
Mobile Number
E Y
L
H A R T
M B O D H
H A K
D E
Telephone Number
1 8 4
1 6
2 6
0 2
2 0 0 5
2 5
0 2
2 0 1 5
Place of Issue
D E
If you have held/ hold any diplomatic/ official passport, provide details in Column 6 of Supplementary Form
7.2 Have you ever applied for passport, but not issued?
File Number
8. Other details
8.1 Have you ever been charged with criminal proceedings or any arrest warrant/ summon
pending before a court in India?
If yes, fill Column 7.1 of Supplementary Form
Yes
No
Page 5 of 6
8.2 Have you at any time during the period of 5 years immediately preceding the date of
this application been convicted by a court in India for any criminal offence & sentenced
to imprisonment for two years or more?
If yes, fill Column 7.2 of Supplementary Form
Yes
No
No
No
No
No
DD Issue Date
Bank Name
DD Expiry Date
-
Branch
10. Enclosures
1.
6.
2.
7.
3.
8.
4.
9.
5.
10.