PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-0008814172
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name AJIT KUMAR SINGH
Date of Birth (DD/MM/YYYY) 12/06/2001
Validity Required NA
Place of Birth (Village/Town/City) CHITAWAL
District SINGRAULI
State/UT MADHYA PRADESH
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN LZWPS6522H
Employment Type SELF EMPLOYED
Is either of your parent (in case of minor)/spouse, a government servant? N
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 944924064879
Family Details
Father's Name LAKSHANDHARI SINGH
Mother's Name SUDHA DEVI
Present Residential Address Details
Address NEAR SON RIVER, CHITAWAL, SINGRAULI, MADHYA PRADESH
PIN 486886
Police Station CHITRANGI
Mobile/Tel No. 9993631604
E-mail AJITSINGH12EXCELLENCE@[Link]
Permanent Residential Address
Address NEAR SON RIVER, CHITAWAL, SINGRAULI, MADHYA PRADESH
PIN 486886
Police Station CHITRANGI
Mobile/Tel No. 9993631604
Emergency Contact Details
Name and Address LAKSHANDHARI
Mobile/Tel No. 8889936406
Other Details
Enclosures
[Link] Card issued by the Income Tax Department
[Link] Card (Address Proof)
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
citizenship of India. I have not contravened any of the conditions relating to the possession and use of an Indian passport.
I affirm that the information and particulars given by me in this form are true and correct. I further state that I am not suppressing any material information in this regard. I further affirm that the enclosures
and documentary proof submitted in support of my application for an Indian passport are authentic and solely pertain to me and I am fully responsible for the accuracy of the same. 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.
I have read and understood the contents of the above and by submitting this form certify that all the information submitted by me in the form is bonafide.
Place SINGRAULI
Date 20/05/2024
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