2/7/2019 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 19-0001927728
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name AYUSH SINGH BAIS
Date of Birth (DD/MM/YYYY) 18/06/1999
Validity Required NA
Place of Birth (Village/Town/City) INDORE
District INDORE
State/UT MADHYA PRADESH
Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
Employment Type STUDENT
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark TATTOO ON RIGHT HAND
Aadhaar Number 456634810324
Family Details
Father's Name SANJAY SINGH BAIS
Mother's Name SONAL SINGH
Present Residential Address Details
13 L.I.G.DUPLEX NEAR NANDA NAGAR CHURCH, INDORE, MIG,
Address
INDORE, MADHYA PRADESH
PIN 452011
Mobile/Tel No. 7389513746
E-mail AYUSHBAIS116@GMAIL.COM
Permanent Residential Address
13 L.I.G.DUPLEX NEAR NANDA NAGAR CHURCH, INDORE, MIG,
Address
INDORE, MADHYA PRADESH
PIN 452011
Mobile/Tel No. 7389513746
Emergency Contact Details
Name and Address MR.SANJAY SINGH 13,L.I.G.DUPLEX NEAR NANDA NAGAR CHURCH
Mobile/Tel No. 7389513746
Other Details
Enclosures
1.Aadhaar Card/E-Aadhaar
2.Driving Licenses (valid and within the jurisdiction of State of submission of application)
Self Declaration
I owe allegiance to the sovereignty, unity and 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 citizenship of India and I affirm that the information given by me in
this form and the enclosures is true and I am solely responsible for its accuracy, and I am liable to be penalized or prosecuted if found
otherwise. I am aware that under the Passports 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.
Place INDORE
Date 07/02/2019

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