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India Passport Application Form - Tatkaal

The document is a passport application form for Priyanka Deshmukh, applying for a fresh normal passport under the Tatkaal service. It includes personal details such as her date of birth, place of birth, and contact information, as well as family details and a self-declaration of the authenticity of the information provided. The application is dated May 23, 2024, and includes necessary enclosures like a PAN card and Aadhaar card.

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ayan sen
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25 views2 pages

India Passport Application Form - Tatkaal

The document is a passport application form for Priyanka Deshmukh, applying for a fresh normal passport under the Tatkaal service. It includes personal details such as her date of birth, place of birth, and contact information, as well as family details and a self-declaration of the authenticity of the information provided. The application is dated May 23, 2024, and includes necessary enclosures like a PAN card and Aadhaar card.

Uploaded by

ayan sen
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

5/23/24, 5:20 PM Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 24-1006638461
Applying For FRESH
Type of Application TATKAAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name PRIYANKA DESHMUKH
Date of Birth (DD/MM/YYYY) 12/08/1999
Validity Required NA
Place of Birth (Village/Town/City) BANKURA
District BANKURA
State/UT WEST BENGAL
Region/Country INDIA
Gender FEMALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN EEFPD8153A
Employment Type PRIVATE
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 CUT MARK IN RIGHT HAND
Aadhaar Number 576018309247
Family Details
Father's Name BIDYUT BIKASH DESHMUKH
Mother's Name MITHU DESHMUKH
Present Residential Address Details
Address VILL-LACHIPUR, LACHAIPUR, LACHIPUR, BANKURA, WEST BENGAL
PIN 722101
Police Station BANKURA
Mobile/Tel No. 7362952619
E-mail DESHMUKHPRIYANKA384@[Link]
Permanent Residential Address
Address VILL-LACHIPUR, LACHAIPUR, LACHIPUR, BANKURA, WEST BENGAL
PIN 722101
Police Station BANKURA
Mobile/Tel No. 7362952619
Emergency Contact Details
Name and Address BIDYUT BIKASH DESHMUKH
Mobile/Tel No. 9735134868
E-mail [Link]@[Link]
Other Details
Enclosures
[Link] Card issued by the Income Tax Department
[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 KOLKATA

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5/23/24, 5:20 PM Application Form
Date 23/05/2024

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