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India Passport Application Form 2019

This document is a passport application form for Thirunavukkarasu Sivakumar, a male student from Coimbatore, Tamil Nadu, applying for a fresh normal passport. The application includes personal details, family information, and enclosures such as a birth certificate and Aadhaar card. The applicant affirms the accuracy of the information provided and acknowledges the legal implications of false information.

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arung3982
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3 views1 page

India Passport Application Form 2019

This document is a passport application form for Thirunavukkarasu Sivakumar, a male student from Coimbatore, Tamil Nadu, applying for a fresh normal passport. The application includes personal details, family information, and enclosures such as a birth certificate and Aadhaar card. The applicant affirms the accuracy of the information provided and acknowledges the legal implications of false information.

Uploaded by

arung3982
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

7/20/2019 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 19-1007003649
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name THIRUNAVUKKARASU SIVAKUMAR
Date of Birth (DD/MM/YYYY) 19/11/1998
Validity Required NA
Place of Birth (Village/Town/City) COIMBATORE
District COIMBATORE
State/UT TAMIL NADU
Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
Employment Type STUDENT
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 335996394054
Family Details
Father's Name SIVAKUMAR CHENNIAPPAN
Mother's Name LATHA SIVAKUMAR
Present Residential Address Details
38,MALLIGAI GARDEN THUDIYALUR, MUTHUNAGAR, COIMBATORE,
Address
COIMBATORE RURAL, TAMIL NADU
PIN 641034
Police Station THUDIYALUR
Mobile/Tel No. 7871208905
E-mail ARUNG3982@[Link]
Emergency Contact Details
Name and Address SIVAKUMAR 38,MALLIGAI GARDEN THUDIYALUR, MUTHUNAGAR
Mobile/Tel No. 7871208905
Other Details
Enclosures
[Link] Certificate issued by the Registrar of Births and Deaths or the Municipal Corporation or any other prescribed authority,whosoever
has been empowered under the Registration of Birth and Deaths Act, 1969 to register the birth of a child born in India
[Link] Card/e-Aadhar containing the 12 digit Aadhaar number issued by the Unique Identification Authority of India(UIDAI)
Self Declaration
I owe allegiance to the sovereignty, unity and 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 and I affirm that the information given by me in this
form and the enclosures is true and I am solely responsible for its accuracy, and 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.
Place COIMBATORE
Date 20/07/2019

[Link] 1/1

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