PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 20-1006126116
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name DEEPAK BHARATHI
Date of Birth (DD/MM/YYYY) 10/06/1999
Validity Required NA
Place of Birth (Village/Town/City) SATHAMBADI
District VILLUPURAM
State/UT TAMILNADU
Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN EYUPD1352N
Employment Type PRIVATE
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification DIPLOMO
Are you eligible for Non-ECR category? Y
Aadhaar Number 710603284107
Family Details
Father's Name BHARATHI
Mother's Name MAHESHWARI
Present Residential Address Details
2/26A,VINAYAGAR KOVIL STREET,SATHAMBADI VILLAGE
Address
GINGEE,VILLUPURAM,TAMILNADU
PIN 604204
Police Station VALATHI
Mobile/Tel No. 7092355249
E-mail AKDEEPAKAK8@[Link]
Emergency Contact Details
Name and Address ARAVIND MURUGAN
Mobile/Tel No. 9035926152
Other Details
Enclosures
[Link]/School leaving/Matriculation Certificate issued by the school last attended/recognised educational board
[Link] Card/e-Aadhar containing the 12 digit Aadhaar number issued by the Unique Identification Authority of India(UIDAI)
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 BANGALORE
Date 21/09/2021