File Number (For Office Use Only)
Ministry of External Affairs, Government of India
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 - 25-1060343009 Please paste your
Number unsigned recent
Applying For - FRESH color photograph
of size 4.5cm *
Type of Application - NORMAL 3.5cm.
Type of Passport Booklet - NORMAL
Applicant Details
Applicant's Name - RAMESH PARUI
Date of Birth - 19/06/1988
(DD/MM/YYYY)
Validity Required - NA Signature/Left Hand Thumb Impression
of Illiterate Applicant and Minors who
Place Of Birth - PATABUKA
cannot sign.
(Village/Town/City)
District - NORTH 24 PARGANAS
State/UT - WEST BENGAL
Region/Country - INDIA
Gender - MALE
Marital Status - MARRIED
Citizenship of India by - BIRTH
PAN - CYSPP3351B
Voter ID - NNR1744531
Employment Type - SELF EMPLOYED
Is either of your parent (in- N
case of minor)/spouse, a
government servant?
Educational Qualification - 7TH PASS OR LESS
Are you eligible for Non- - N
ECR category
Aadhaar Number - 515650121380
Family Details
Father Name - SANKAR PARUI
Mother Name - MAYA PARUI
Spouse's Name - BASANTI PARUI
Present Residential Address Details:
Address - PATABUKA NATAGRAM, PATABUKA, BONGAON, WEST BENGAL
Pin - 743249
Police Station - GAIGHATA
Mobile/Tel No - 6294003464
Email - MEGAGAMINGHUNTER2020@[Link]
Permanent Residential Address Details
Address - PATABUKA NATAGRAM, PATABUKA, BONGAON, WEST BENGAL
Pin - 743249
Police Station - GAIGHATA
Mobile/Tel No - 6294003464
EmergencyContactDetails:
Name and Address - BASANTI PARUI, PATABUKA, NATAGRAM, GAIGHATA, NORTH 24 PARGANAS,
743249
Mobile/Tel No. - 6294003464
E-mail - SUPTISARKAR99@[Link]
Previous Passport
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:
1. Aadhaar Card (Address Proof)2. Permanent Account Number Card issued by the Income-tax Department having the date of
birth of the applicant
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 - PATABUKA
Signature/Left Hand Thumb Impression of
Applicant (If applicant is minor, either parent
Date - 01/09/2025
to sign)