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India Passport Reissue Application Form

The document is a passport application form for Swapneel Prasanth Mishra from India. It includes personal details like name, date of birth, address, contact information, as well as family details. It specifies that Swapneel is applying for a reissue of his passport due to its expiration within 3 years and lists details of his previous passport like the passport number and place of issue. The form is dated June 8, 2016 and includes a self-declaration by Swapneel that the information provided is true.

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Swapneel Prasanth Mishra
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13 views2 pages

India Passport Reissue Application Form

The document is a passport application form for Swapneel Prasanth Mishra from India. It includes personal details like name, date of birth, address, contact information, as well as family details. It specifies that Swapneel is applying for a reissue of his passport due to its expiration within 3 years and lists details of his previous passport like the passport number and place of issue. The form is dated June 8, 2016 and includes a self-declaration by Swapneel that the information provided is true.

Uploaded by

Swapneel Prasanth Mishra
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

6/8/2016

ApplicationForm

PASSPORTAPPLICATIONFORM
GovernmentofINDIA,MinistryofExternalAffairs
ServiceRequired
ApplicationReferenceNumber
ApplyingFor
IfReissue,specifyreason(s)
TypeofApplication
TypeofPassportBooklet

161005045139
REISSUE
VALIDITYEXPIREDWITHIN3YEARS/DUETOEXPIRE.
NORMAL
JUMBO

ApplicantDetails
Applicant'sName
DateofBirth(DD/MM/YYYY)
ValidityRequired
PlaceofBirth(Village/Town/City)
District
State/UT
Country
Gender
MaritalStatus
CitizenshipofIndiaby
PAN
EmploymentType
Iseitherofyourparent(incaseof
minor)/spouse,agovernmentservant?
EducationalQualification
AreyoueligibleforNonECRcategory?
VisibleDistinguishingMark
AadhaarNumber

SWAPNEELPRASANTHMISHRA
26/04/1985
NA
BAGDEHI
JHARSUGUDA
ODISHA
INDIA
MALE
MARRIED
BIRTH
AQCPM4525E
PRIVATE
N
GRADUATEANDABOVE
Y
SCARONRIGHTHAND
990697727958

FamilyDetails
Father'sName
Mother'sName
Spouse'sName

MOHANKUMARMISHRA
JAYASHREEMISHRA
DEEPIKADASH

PresentResidentialAddressDetails
ResidingSince(MM/YYYY)
Address
PIN
Mobile/TelNo.
Email
FirstReferenceNameAndAddress
Mobile/TelNo.
SecondReferenceNameAndAddress
Mobile/TelNo.

12/2014
1482NDFLOOR1STMAIN3RDCROSSMALLAPPALAYOUT,BANGALORE,
HENNUR,BENGALURU,KARNATAKA
560043
9740700994/09740700994
SWAPNEELMISHRA@[Link]
PARIKANNAPPANNO14THCROSS3RDBLOCK,DASAPPA
LAYOUT,RAMMURTHYNAGAR560016
9986432541
TAPANSAMALNO27GRNDFLOORASHIRWADCOLONYP&TLAYOUT
HORAMAVU,LANDMARKDEVAMATHACENTRALSCHOOL
9036122894

PermanentResidentialAddress
Address
PIN
Mobile/TelNo.

HIG4SDACOLONY,SAMBALPUR,BURLA,SAMBALPUR,ODISHA,INDIA
768017
09437125001/09437125001

EmergencyContactDetails
NameandAddress
Mobile/TelNo.
Email

MOHANKUMARMISHRA,E4/34AREA7&8CIVILTOWNSHIPROURKELA
769004
9437125001/06612664984
MOHAN_WESCO@[Link]

[Link]

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6/8/2016

ApplicationForm

PreviousPassport/ApplicationDetails
Detailsoflatestheld/existing/lost/damagedOrdinaryPassport
PassportNumber
DateofIssue
DateofExpiry
PlaceofIssue
FileNumber

G0596212
13/12/2006
12/12/2016
BHUBANESWAR
BHUA02162806

OtherDetails
SelfDeclaration
Ioweallegiancetothesovereignty,unityandintegrityofIndia,andhavenotvoluntarilyacquiredcitizenshiportraveldocument
[Link],surrenderedorbeendeprivedofthecitizenshipofIndiaandIaffirmthattheinformation
givenbymeinthisformandtheenclosuresistrueandIamsolelyresponsibleforitsaccuracy,andIamliabletobepenalized
[Link],1967itisacriminaloffencetofurnishanyfalse
informationortosuppressanymaterialinformationwithaviewtoobtainingpassportortraveldocument.
Place
BANGALORE
Date
08/06/2016

[Link]

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