PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 18-0010802938
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name DHRUV RAJESHBHAI PAREKH
Date of Birth (DD/MM/YYYY) 29/03/2000
Validity Required NA
Place of Birth (Village/Town/City) BARDOLI
District SURAT RURAL
State/UT GUJARAT
Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN EMYPP2030K
Employment Type STUDENT
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? N
Aadhaar Number 956633570137
Family Details
Father's Name RAJESH MANEKLAL PAREKH
Mother's Name HEMANGINI RAJESH PAREKH
Present Residential Address Details
102,CHINMAY COMPLEX,SHASTRI ROAD, BARDOLI, BARDOLI,
Address
BARDOLI, SURAT RURAL, GUJARAT
PIN 394601
Mobile/Tel No. 9228409899
E-mail RAJESHPAREKH_2712@YAHOO.CO.IN
Permanent Residential Address
102,CHINMAY COMPLEX,SHASTRI ROAD, BARDOLI, BARDOLI,
Address
BARDOLI, SURAT RURAL, GUJARAT
PIN 394601
Mobile/Tel No. 9228409899
Emergency Contact Details
Name and Address RAJESH PAREKH
Mobile/Tel No. 9228409899
E-mail RAJESHPAREKH_2712@YAHOO.CO.IN
Other Details
Enclosures
1.Birth Certificate issued by the Registrar of Births and Deaths or the Municipal Corporation or any other prescribed
authority,whosoever has been empowered under the Registration of Birth and Deaths Act, 1969 to register the birth of a child
born in India
2.Aadhaar Card
Self Declaration
I owe allegiance to the sovereignty, unity and 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 and I affirm that the information
given by me in this form and the enclosures is true and I am solely responsible for its accuracy, and 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.
Place SURAT
Date 16/07/2018