6/27/24, 11:57 AM Application Form
PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 24-0011255788
Applying For REISSUE
If Re-issue, specify reason(s) VALIDITY EXPIRED WITHIN 3 YEARS/DUE TO EXPIRE.
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name NAMIT KUMAR
Date of Birth (DD/MM/YYYY) 11/10/2004
Validity Required NA
Place of Birth (Village/Town/City) NEW DELHI
District NEW DELHI
State/UT DELHI
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN FWTPK5096Q
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 NO
Aadhaar Number 523027981189
Family Details
Father's Name VINOD KUMAR
Mother's Name GEETA
Present Residential Address Details
41/41 HOUSE NUMBER, FLAT NUMBER 11, PUNJABI BAGH, NEW DELHI,
Address
WEST DELHI, DELHI
PIN 110026
Police Station PUNJABI BAGH
Mobile/Tel No. 09999813936
E-mail NAMIT.ARORA4545@[Link]
Permanent Residential Address
41/41 HOUSE NUMBER, FLAT NUMBER 11, PUNJABI BAGH, NEW DELHI,
Address
WEST DELHI, DELHI
PIN 110026
Police Station PUNJABI BAGH
Mobile/Tel No. 09999813936
Emergency Contact Details
NAMIT, 41 ROAD NUMBER, 41 HOUSE NUMBER, FLAT NUMBER 11, PUNJABI
Name and Address
BAGH WEST (NEW DELHI)
Mobile/Tel No. 09999813936
E-mail NAMIT.ARORA4545@[Link]
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number R9654249
Date of Issue 24/05/2018
Date of Expiry 10/10/2022
Place of Issue DELHI
Other Details
Enclosures
[Link] Card issued by the Income Tax Department
[Link] Card (Address Proof)
[Link] stating how and where the Passport got lost/ damaged as per Annexure F
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6/27/24, 11:57 AM Application Form
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 NEW DELHI
Date 27/06/2024
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