1/8/23, 12:33 PM View/Print Submitted Form
File Number (For Office Use Only)
GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS
PASSPORT APPLICATION FORM
Please read the Passport Instruction Booklet carefully before filling the form. Fill this form in CAPITAL LETTERS using
blue/black ink ball point pen only. Furnishing of incorrect information/ suppression of information would lead to rejection of the
application and would attract penal provisions as prescribed under the Passports Act, 1967. Please produce your original
documents at the time of submission of the form.
Service Required
Application Reference Number 23-1000318275
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name ZEENATH SAIRA
Date of Birth (DD/MM/YYYY) 23/12/1996
Validity Required NA
Place of Birth (Village/Town/City) KARIMNAGAR
District KARIMNAGAR
State/UT TELANGANA
Region/Country INDIA
Signature/Left Hand Thumb Impression
Gender FEMALE of Illiterate Applicant and Minors who
Marital Status MARRIED cannot sign.
Citizenship of India by BIRTH
PAN PEPPS5581Q
Employment Type NOT EMPLOYED
Is either of your parent (in case of
N
minor)/spouse, a government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark A MOLE ON NOSE
Aadhaar Number 653885021885
Family Details
Father's Name GULAM SHAJHI
Mother's Name TAHSEEN SULTANA
Spouse's Name ZUBAIR AHMED
Present Residential Address Details
H NO ST2-1601, CENTENARY COLONY, KARIMNAGAR,
Address
RAMAGUNDAM-PEDDAPALLI, TELANGANA
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1/8/23, 12:33 PM View/Print Submitted Form
PIN 505212
Police Station RAMAGIRI
Mobile/Tel No. 8639939034
E-mail SAIRAZEE0000@[Link]
Emergency Contact Details
NC 95 , CENTENARY COLONY,RAMAGIRI
Name and Address
(M),,PEDDAPALLY(D)
Mobile/Tel No. 8332975318
E-mail SAIRAZEE0000@[Link]
Other Details
Fee Details (Not to be filled by applicants submitting the application at Passport Seva Kendra/Passport Office)
Fee amount in (Rs)
If paid by Demand Draft(DD), provide the following details
DD Issue Date (dd/mm/yyyy)
DD Expiry Date (dd/mm/yyyy)
Bank Name
Branch
Enclosures
[Link] Card/E-Aadhaar
[Link]'s passport copy (First and last page including family details)
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.
CENTENARY
Place Signature/Left Hand Thumb Impression of
COLONY
Applicant (If applicant is minor, either parent
to sign)
Date 08/01/2023
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