14/03/2025, 10:44 Application Form
PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 25-1003069663
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name JOEL THOMAS
Date of Birth (DD/MM/YYYY) 10/12/2002
Validity Required NA
Place of Birth (Village/Town/City) THIRUVANANTHAPURAM
District KOTTAYAM
State/UT KERALA
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN CFUPT5097M
Voter Id UAH1066638
Employment Type NOT EMPLOYED
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark A BLACK MOLE ON THE LEFT SHOULDER
Aadhaar Number 896820745452
Family Details
Father's Name THOMASKUTTY CHACKO
Mother's Name SALYKUTTY THOMAS
Present Residential Address Details
PUTHENPURACKAL (H), PULICKALKAVALA, VAZHOOR, KOTTAYAM,
Address
KERALA
PIN 686515
Police Station PALLICKATHODU
Mobile/Tel No. 7907423630 / 04812991394
E-mail JOOELLTHOMAS@[Link]
Permanent Residential Address
PUTHENPURACKAL (H), PULICKALKAVALA, VAZHOOR, KOTTAYAM,
Address
KERALA
PIN 686515
Police Station PALLICKATHODU
Mobile/Tel No. 7907423630 / 04812991394
Emergency Contact Details
Name and Address THOMASKUTTY CHACKO
Mobile/Tel No. 9446641310
E-mail TCHACKO12@[Link]
Other Details
Enclosures
[Link] licence issued by the Transport Department of the concerned State Government, having the date of birth of the applicant
[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.
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14/03/2025, 10:44 Application Form
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 KOTTAYAM
Date 14/03/2025
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