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    Government of India, Ministry of External Affairs: Service Required

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    Sidkrish
    Saurabh Shrivastava, a 28-year-old married man from Azamgarh, Uttar Pradesh, India applied for a fresh normal passport. He submitted his passport application form along with documents including his Aadhaar card, address proof, payment receipt, and self-declaration. In the form, he provided personal details like name, date of birth, parents' names, address, employment, education and other identification numbers. He declared his allegiance to India and affirmed that the information provided was true.

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    Government of India, Ministry of External Affairs: Service Required

    Uploaded by

    Sidkrish
    41 views2 pages
    Saurabh Shrivastava, a 28-year-old married man from Azamgarh, Uttar Pradesh, India applied for a fresh normal passport. He submitted his passport application form along with documents including his Aadhaar card, address proof, payment receipt, and self-declaration. In the form, he provided personal details like name, date of birth, parents' names, address, employment, education and other identification numbers. He declared his allegiance to India and affirmed that the information provided was true.

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    Passport1

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    Saurabh Shrivastava, a 28-year-old married man from Azamgarh, Uttar Pradesh, India applied for a fresh normal passport. He submitted his passport application form along with documents including his Aadhaar card, address proof, payment receipt, and self-declaration. In the form, he provided personal details like name, date of birth, parents' names, address, employment, education and other identification numbers. He declared his allegiance to India and affirmed that the information provided was true.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    41 views2 pages

    Government of India, Ministry of External Affairs: Service Required

    Uploaded by

    Sidkrish
    Saurabh Shrivastava, a 28-year-old married man from Azamgarh, Uttar Pradesh, India applied for a fresh normal passport. He submitted his passport application form along with documents including his Aadhaar card, address proof, payment receipt, and self-declaration. In the form, he provided personal details like name, date of birth, parents' names, address, employment, education and other identification numbers. He declared his allegiance to India and affirmed that the information provided was true.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    11/6/21, 8:33 AM 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 21-0010531344  
     
    Applying For FRESH

    Type of Application NORMAL

    Type of Passport Booklet NORMAL


    Applicant Details
    Applicant's Name SAURABH SHRIVASTAVA

    Date of Birth (DD/MM/YYYY) 06/02/1993

    Validity Required NA   

    Place of Birth (Village/Town/City) AZAMGARH

    District AZAMGARH

    State/UT UTTAR PRADESH

    Region/Country INDIA
    Signature/Left Hand Thumb Impression
    Gender MALE of Illiterate Applicant and Minors
    who
    Marital Status MARRIED cannot sign.
     
    Citizenship of India by BIRTH  
     
    PAN CJAPS6236F

    Voter Id RQQ2765956

    Employment Type PRIVATE

    Is either of your parent (in case of


    Y
    minor)/spouse, a government servant?

    Educational Qualification GRADUATE AND ABOVE

    Are you eligible for Non-ECR category? Y

    Aadhaar Number 483725108223

    Family Details
    Father's Name KAUSHAL KISHOR SHRIVASTAVA

    Mother's Name SUMAN SHRIVASTAVA

    Spouse's Name KAUSHAL KISHOR SHRIVASTAVA

    https://portal1.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=21-0010531344 1/2
    11/6/21, 8:33 AM View/Print Submitted Form
    Present Residential Address Details
    Address HOUSE NO 60, VIJAIPUR, AZAMGARH, UTTAR PRADESH

    PIN 276128

    Police Station MEHNAGAR

    Mobile/Tel No. 9452944952

    E-mail RS.100RABH@GMAIL.COM
    Permanent Residential Address
    Address HOUSE NO 60, VIJAIPUR, AZAMGARH, UTTAR PRADESH

    PIN 276128

    Police Station MEHNAGAR

    Mobile/Tel No. 9452944952


    Emergency Contact Details
    Name and Address VISHAL SHRIVASTAVA VIJAIPUR DEEHA AZAMGARH

    Mobile/Tel No. 8935002003

    E-mail SRIVISHAL5792@GMAIL.COM
    Other Details
    Payment Details
    Mode of Payment UPI

    Date 04/11/2021

    Receipt/Reference No. CPABEKAHD3

    Amount Received (Rs.) 1500.00  (ONE THOUSAND FIVE HUNDRED ONLY)


    Enclosures
    1.Aadhaar Card/E-Aadhaar

    2.Aadhaar 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 AZAMGARH Signature/Left Hand Thumb Impression of


    Applicant
    (If applicant is minor, either parent
    Date 04/11/2021 to sign)

    https://portal1.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=21-0010531344 2/2

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