PASSPORT & VISA SOLUTION

226/1/2 CP BYE LANE NIMTA,SUBHASPALLY

PH- 8443069982,8961036692,9681423268
EmailId:passport1993@gmail.com

CUSTOMER REGISTRATION
FORM
1.
2.
3.
4.
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7.
8.

Passport Office ___________________________________________________________

Name
___________________________________________________________
Surname
____________________________________________________________
Date of Birth (DD/MM/YYYY)____________________________
Apply for
(FRESH/REISSUE)
Type
(NORMAL/TATKAL)

Have you ever changed your name?

(Y/N)

Place of Birth (Village/Town/City)

*___________________________________________
9. State__________________________________________________________________
_
10. District________________________________________________________________
__
11. Gender
( M/F)
12. Marital
Status____________________________________________________________
13. Citizenship of India by
(BIRTH/REGISTRATION)
14. Pan or votercard no
_______________________________________________________
15. Employment Type
*_______________________________________________________
16. Is either of your parent (in case of minor)/spouse, a government
servant? (Y/N)
17. Educational
qualification___________________________________________________
18. Aadhaar Number (if
available)_______________________________________________
19. Father's Given
Name______________________________________________________
20. Mother's Given
Name_____________________________________________________
21. Spouse's Given Name
_____________________________________________________
22. Residing Since
(YEAR)______________________________________________________

23. House No. and Street Name

*_______________________________________________

24. Village/Town/City_______________________________________________________
__

25. State/UT
*_______________________________________________________________
26. Police
Station____________________________________________________________
27. PIN
Code________________________________________________________________
28. Mobile Number
*_________________________________________________________
29. Telephone_____________________________________________________________
__
30. E-mail
Id_________________________________________________________________
31. First Reference Name and Address And Mobileno
___________________________________________________________________________
32. Second Reference Name and Address And Mobileno