2/7/25, 1:08 PM Application Form
PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 25-1001671767
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name REKHA DHAYALAN
Date of Birth (DD/MM/YYYY) 09/06/1998
Validity Required NA
Place of Birth (Village/Town/City) PUTHUPET
District CUDDALORE
State/UT TAMIL NADU
Region/Country INDIA
Gender FEMALE
Marital Status SINGLE
Citizenship of India by BIRTH
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
Aadhaar Number 621381275708
Family Details
Father's Name DHAYALAN
Mother's Name ANANTHI
Present Residential Address Details
NO 6 MEENATCHI AMMAN PETTAI STREET THORAPADI, PUTHUPET POST, PANRUTI TK,
Address
CUDDALORE, TAMIL NADU
PIN 607108
Police Station PUDUPET
Mobile/Tel No. 9751545104
E-mail [Link].E.T@[Link]
Permanent Residential Address
NO 6 MEENATCHI AMMAN PETTAI STREET THORAPADI, PUTHUPET POST, PANRUTI TK,
Address
CUDDALORE, TAMIL NADU
PIN 607108
Police Station PUDUPET
Mobile/Tel No. 9751545104
Emergency Contact Details
Name and Address DHAYALAN
Mobile/Tel No. 9843753239
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.
Place PANRUTI
Date 07/02/2025
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