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Given Name and Passport Information Booklet Essay

Please read the Passport Information Booklet carefully before filling the form. Furnishing of incorrect information/ suppression of information would lead to rejection of application and would attract penal provisions as prescribed under the Passports Act, 1967. Please produce your original documents at the time of submission of the form. All fields marked with (*) are mandatory to fill.

PASSPORT APPLICATION FORM Government of India, Ministry of External Affairs

Service Required Applying for * Type of Application * Type of Passport Booklet * Validity Required (For minors between 15 and 18) Normal 36 Pages 10 years Tatkaal 60 Pages Up to age 18 Not Applicable

Applicant Details Applicant’s Given Name (Given Name means First Name followed by middle Name (if any)) * Surname Are you known by any other names(aliases)? * Have you ever changed your name ? * Date of Birth (DD/MM/YYYY) * Place Of Birth Village or Town or City * Country (If abroad)* State (If in India)* Gender * PAN (If available) Employment Type * Is either of your parent (in case of minor)/ spouse, a government servant? * Educational Qualification * Visible Distinguishing Mark Family Details (You have to provide atleast one Father/Mother/Legal Guardian details.) Father’s Given Name (Given Name means First Name followed by Middle Name (If any)) Surname Legal Guardian’s Given Name (if applicable) Surname Mother’s Given Name (Given Name means First Name followed by Middle Name (If any)) Are you eligible for Non-ECR category? * Yes Yes No No

District (If in India)* Marital Status * Citizenship of India by *

If born before 15/08/1947 in a place now in Pakistan or Bangladesh, select “Undivided India”.

Voter ID (If available)

Page of

Surname Present Residential Address details (where applicant presently resides) Is your present address out of India? * Is permanent address same as present address? * Emergency Contact Details * Name and Address * Yes Yes No No

Mobile Number E-mail ID References in your Village or Town or City First Reference Name and Address *

Telephone Number

Mobile Number Second Reference Name and Address *

Telephone Number

Mobile Number Previous Passport/ Application Details

Telephone Number

Have you held/ hold any diplomatic/ official passport? Passport Number Date of Expiry (DD/MM/YYYY) Place of Issue Have you ever applied for passport, but not issued? * Other Details 1) Have you ever been charged with criminal proceedings or any arrest warrant/ summon pending before a court of India? * 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 and sentenced to imprisonment for two years or more? * 3) Have you ever been refused or denied passport? * 4) Has your Passport ever been impounded or Revoked? * 5) Have you ever applied for/ been granted political asylum to/ by any foreign country? * 6) Have you ever returned to India on Emergency Certificate (EC) or were ever deported or repatriated? * Yes Yes No No Yes No Date of Issue(DD/MM/YYYY)

Yes Yes Yes Yes

No No No No

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 the citizenship of India and I affirm that the information given by me in this form and the enclosures is true and I solely responsible for its accuracy, and I am liable to be penalized or prosecuted if found otherwise. I am aware that under the Passport 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 Agree Place


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