Scribd
Upload
6 views2 pages

Application Form

The document is a passport application form for UPPARA MANASA, a female student born on January 5, 1999, from Devarabanda Village, Andhra Pradesh, India. The application is for a fresh normal passport, and includes personal details, family information, residential addresses, and a self-declaration of the authenticity of the provided information. Enclosures include a school certificate and Aadhaar card for address proof.

Uploaded by

jagadeeshbattula111211
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
6 views2 pages

Application Form

The document is a passport application form for UPPARA MANASA, a female student born on January 5, 1999, from Devarabanda Village, Andhra Pradesh, India. The application is for a fresh normal passport, and includes personal details, family information, residential addresses, and a self-declaration of the authenticity of the provided information. Enclosures include a school certificate and Aadhaar card for address proof.

Uploaded by

jagadeeshbattula111211
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

11/9/24, 6:37 PM Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-1013682079
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name UPPARA MANASA
Date of Birth (DD/MM/YYYY) 05/01/1999
Validity Required NA
Place of Birth (Village/Town/City) DEVARABANDA VILLAGE
District NANDYAL
State/UT ANDHRA PRADESH
Region/Country INDIA
Gender FEMALE
Marital Status SINGLE
Citizenship of India by BIRTH
Employment Type STUDENT
Is either of your parent (in case of minor)/spouse,
N
a government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark A BLACK MOLE ON THE RIGHT FINGER
Aadhaar Number 964848725936
Family Details
Father's Name SHRINIVASULU UPPARA
Mother's Name ANURADHA UPPARA
Legal Guardian's Name MAHESH UPPARA
Present Residential Address Details
H NO 87-1187-5E, NAGIREDDY REVENUE COLONY-2, KURNOOL, KURNOOL,
Address
ANDHRA PRADESH
PIN 518002
Police Station KURNOOL III TOWN
Mobile/Tel No. 9133214073
E-mail MANASASAGAR77@[Link]
Permanent Residential Address
H/NO.2-149-A,DHONE MANDAL,DEVARABANDA, DEVARABANDA VILLAGE,
Address
NANDYAL, ANDHRA PRADESH, INDIA
PIN 518221
Police Station DHONE RURAL
Mobile/Tel No. 9133214073
Emergency Contact Details
Name and Address U MAHESH, H NO 87/1108-26-A
Mobile/Tel No. 8179797907
Other Details
Enclosures
[Link]/School leaving/Matriculation Certificate issued by the school last attended/recognized educational board
[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.

[Link] 1/2
11/9/24, 6:37 PM Application Form
Place KURNOOL
Date 09/11/2024

[Link] 2/2

You might also like