2190 PARAISO STREET, DASMARINAS VILLAGE, MAKATI CITY, METRO MANILA.

P.O. BOX NO. 2123 MCPO, MAKATI CITY, METRO MANILA, PHILIPPINES
632-88430101 https://www.eoimanila.gov.in/
PASSPORT PREVIEW

भारत गणराज्य REPUBLIC OF INDIA

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टाइप/Type राष्ट्र कोड/CountryCode पासपोर्ट नं./PassportNo.

P IND

Paste your unsigned उपनाम/Surname

recent color

photograph Size 2"X2" दिया गया नाम/Given Name(s)

and Signature/Left PRITAM SINGH

Hand Thumb राष्ट्रीयता/Nationality लिंग/Sex जन्मतिथि/Date of Birth

Impression in the box INDIAN M 24/04/1953

provided below जन्म स्थान/Place of Birth

BOPA RAI KHURD, PUNJAB

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जारी करने का स्थान/Place of Issue

जारी करने की तिथि/Date of Issue समाप्ति की तिथि/Date of Expiry

पिता/कानूनी अभिभावक का नाम/Name of Father/Legal Guardian

JIWAN SINGH

माता का नाम/Name of Mother

GURNAM KAUR

पति या पत्नी का नाम/Name of Spouse

CHARAN KAUR

पता/Address

524-B MAKILING STREET

BRGY. MALAMIG/ MANDALUYONG CITY

PHILIPPINES 1550

पुराने पासपोर्ट का नं. और इसके जारी होने की तिथि एवं स्थान/Old Passport No with Date and Place of Issue

L6781612 10/03/2014 MANILA

फ़ाइल नं./File No.

Service Required
Application Reference Number (ARN) 24-2003125588
Applying For REISSUE
If Re-issue, specify reason(s) VALIDITY EXPIRED WITHIN 3 YEARS/DUE TO EXPIRE.
Type of Application NORMAL
Type of Passport Booklet 60 Pages
Applicant Details
Applicant's Name PRITAM SINGH
Applicant's Alias Name N
Applicant's Change In Name N
Date of Birth (DD/MM/YYYY) 24/04/1953
Validity Required NA
Place of Birth (Village/Town/City) BOPA RAI KHURD
District LUDHIANA
State/UT PUNJAB
Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
Employment Type SELF EMPLOYED
Is either of your parent (in case of minor)/spouse, a government
servant? N
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y

Family Details(as in passport)

Father's Name JIWAN SINGH
Mother's Name GURNAM KAUR
Spouse's Name CHARAN KAUR
Passport Printable Address Details
524-B MAKILING STREET BRGY. MALAMIG/ MANDALUYONG CITY
To be printed on passport
Philippines 1550
Mobile/Telephone Number 639770669000
E-mail JAGROOPSINGHSAMRA2@GMAIL.COM
Other Address Details
Address MEHRA PATTI BOPA RAI KHURD, JAGRAON (LUDHIANA)
PIN:141109, PUNJAB, INDIA
Mobile/Telephone Number 919463942674
Emergency Contact Details
JAGROOP SINGH SAMRA, 524-B MAKILING STREET, BRGY
Name and Address
MALAMIG, MANDALUYONG CITY, PHILIPPINES
Mobile/Telephone Number 639770669000
E-mail JAGROOPSINGHSAMRA2@GMAIL.COM
Previous Passport
Passport Number L6781612
Date of Issue 10/03/2014
Date of Expiry 09/03/2024
Place of Issue MANILA
File Number PHLM00030814
Have you ever applied for passport, but not issued?
N
Details of Previous/Current Diplomatic/Official Passport
N

Other Details
1) Provide the following details if there are any criminal proceedings pending against the applicant.
1.1) Are any proceedings in respect of an offence alleged to have been committed by you pending before a criminal court in India? N
1.2) Has any warrant or summons for your appearance been issued and pending before a court under any law for the time being in force? N
1.3) Has a warrant for your arrest been issued by a court under any law for the time being in force? N
1.4) Has an order prohibiting your departure from India been made by any court? N
2) Provide the following details if the applicant has been convicted by a court in India.
2.1) Have you at any time during the period of five years immediately preceding the date of this application been convicted by a court in India for any
offence involving moral turpitude and sentenced in respect thereof to imprisonment for not less than two years? N
3) Provide the following details if the applicant has been refused/denied passport.
3.1) Have you ever been refused/denied passport? N
3.2) Has your passport ever been impounded? N
3.3) Has your passport ever been revoked? N
4) Provide the following details if applicant has applied for or been granted foreign citizenship.
4.1) Have you ever applied for or been granted citizenship by any other country? N
4.2) Have you ever held the passport of any other country at any time? N
4.3) Have you ever surrendered your Indian passport? N
4.4) Have you ever applied for renunciation of Indian citizenship? N
5) Provide the following details if applicant has returned to India on Emergency Certificate.
5.1) Have you ever returned to India on Emergency Certificate (EC)? N
5.2) Have you ever been deported from any country? N
5.3) Have you ever been repatriated from any country back to India? N
Self Declaration
I declare:

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.
I understand:

That Ministry of External Affairs (MEA) (or its implementation partner agencies/stakeholders/third parties) may undertake required checks to confirm the accuracy
and authenticity of evidence I have provided and documents I have submitted with this application.
That the information I provide, including biometric data (if any), will be treated in confidence, but it may be disclosed to other government departments, agencies,
local authorities, foreign governments, and other implementation partner agencies/stakeholders/third parties to enable MEA or those bodies to perform their
duties.
That providing biometric information, if collected as part of an application, is confirmation of my consent to getting the biometric information checked to verify
identity.
That the Passport and related services applications may be handled by the Indian Embassies/Consulates/ Passport Office/other offices including outside of the
country in which I have applied and that this may involve the transfer of my application and supporting documents to and from the respective offices.
That my details may, in certain circumstances, be passed to Police, Intelligence and other Fraud Detection & Prevention agencies. I also understand that such
agencies may provide related information about me to MEA.

Place MANILA
Signature/Left Hand Thumb Impression of Applicant
CITY
(If applicant is minor, either parent to sign)
Date 05/07/2024