3/28/24, 6:28 PM Application Form
PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 24-1004138241
Applying For FRESH
Type of Application TATKAAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name SANATH PALAKKUNNUMMAL
Date of Birth (DD/MM/YYYY) 21/10/1997
Validity Required NA
Place of Birth (Village/Town/City) KARASSERY
District KOZHIKODE RURAL
State/UT KERALA
Region/Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN PKVPS9993G
Voter Id WYO0545137
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 A BLACK MOLE ON RIGHT SIDE OF NOSE
Aadhaar Number 253444070145
Family Details
Father's Name KUNHIMON PALAKKUNNUMMAL
Mother's Name BINDU
Legal Guardian's Name KUNHIMON PALAKKUNNUMMAL
Present Residential Address Details
PALAKKUNNUMMAL,KARASSERY, MUKKAM, KOZHIKODE RURAL,
Address
KERALA
PIN 673602
Police Station MUKKAM
Mobile/Tel No. 7012528195
E-mail SANATHPK235@[Link]
Permanent Residential Address
PALAKKUNNUMMAL,KARASSERY, MUKKAM, KOZHIKODE RURAL,
Address
KERALA
PIN 673602
Police Station MUKKAM
Mobile/Tel No. 7012528195
Emergency Contact Details
Name and Address KUNHIMON PALAKKUNNUMMAL
Mobile/Tel No. 9846825843
Other Details
Enclosures
[Link]/School leaving/Matriculation Certificate issued by the school last attended/recognized educational board
[Link] Photo Identity Card (EPIC)
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.
[Link] 1/2
3/28/24, 6:28 PM Application Form
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 KARASSERY
Date 28/03/2024
[Link] 2/2