Application Form

1 of 1

https://portal1.passportindia.gov.in/AppOnlineProject/secure/openPdfFo...

Passport Application
Government of India, Ministry
Online Application Receipt
Applicant Details:
Application Reference No.
Service Type
Type of Application
Application Submitted Date
Date of Birth
Gender
Employment Type
Marital Status
Place of Birth
Given Name
Surname
Father's Name
Mother's Name
Present Address
Applicants References:
First Reference Details
Second Reference Details
Payment Details:
Total Fee (Rs.)
Paid Fee (Rs.)
Date and Time
Transaction Id

of External Affairs

ATM facility available at PSK

for all Bank Cards

14-0007947198
FRESH
Batch
11
Normal
Sequence No.
30
01/08/2014
Reporting Time
11:45 AM
09/08/1991
MALE
STUDENT
SINGLE
ALIGARH,ALIGARH
ABHISHEK KUMAR
SINGH
INDRA PAL SINGH
MEENA SINGH
L.I.G - 45 A.D.A COLONY PALA ROAD, ALIGARH, ALIGARH, 202001, UTTAR PRADESH, INDIA
INDRA PAAL SINGH H.NO.L.I.G-45 A.D.A COLONY PALA ROAD VIKAS NAGAR ALIGARH,
9927170376
INDRA PAL SINGH H.NO.63 KESHOPUR GADRANA, THANA QUARSI ,ALIGARH, 9837059780

1500.00
1500.00
02/08/2014 07:10 PM
CP08501945

Appointment Details:
PSK Location
Date and Time of Appointment
Appointment Id
Reporting Time

Ghaziabad,
PASSPORT SEVA KENDRA, BLOCK-A GROUND FLOOR, PACIFIC
BUSINESS PARK, PLOT NO 37/1, SITE IV, SAHIBABAD INDUSTRIAL
AREA, GHAZIABAD - 201010
16/09/2014 & 12:00 PM
100005359822714
11:45 AM

Thanks for showing your interest in 'Passport Seva SMS Services' enrolment. Please pay Rs 30/- (THIRTY ONLY) in cash as the
Enrolment Charges during your visit to Passport Seva Kendra.
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.
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.

8/3/2014 12:04 Hackett