PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 19-1010027281
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name VARADARAJU CHILLAGATTA
Date of Birth (DD/MM/YYYY) 10/06/1964
Validity Required NA
Place of Birth (Village/Town/City) HINDUPUR
District ANANTAPUR
State/UT ANDHRA PRADESH
Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN ADJPC8272E
Voter Id FJX0502245
Employment Type GOVERNMENT
Organisation name SAINIK SCHOOL KORUKONDA
Is either of your parent (in case of minor)/spouse,
N
a government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark A BLACK MOLE ON RIGHT THUMB
Aadhaar Number 405896165648
Family Details
Father's Name VENKATANARANAIAH KRISHNAIAH CHILLAGATTA
Mother's Name SAVITRAMMA CHILLAGATTA
Spouse's Name NAGAVENI RADHAKRISHNAN PAPPUCHETTI
Present Residential Address Details
STAFF QUARTERS,SAINIK SCHOOL KORUKONDA, KORUKONDA, VIZIANAGARAM,
Address
ANDHRA PRADESH
PIN 535214
Police Station VIZIANAGARAM RURAL
Mobile/Tel No. 9490377612
E-mail CVRAJU.1964@GMAIL.COM
Permanent Residential Address
STAFF QUARTERS,SAINIK SCHOOL KORUKONDA, KORUKONDA, VIZIANAGARAM,
Address
ANDHRA PRADESH
PIN 535214
Police Station VIZIANAGARAM RURAL
Mobile/Tel No. 9490377612
Emergency Contact Details
PAPPUCHETTI RADHAKRISHNAN. DOOR NUMBER:233,15TH CROSS,VIJAYANAGARA
Name and Address
RAILWAY LAYOUT,MYSORE. PIN:570016
Mobile/Tel No. 8277553568
Other Details
Enclosures
1.Aadhaar Card/E-Aadhaar
2.Aadhaar Card/e-Aadhar containing the 12 digit Aadhaar number issued by the Unique Identification Authority of India(UIDAI)
3.No Objection Certificate (NOC) as per Annexure G
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 SAINIK SCHOOL KORUKONDA
Date 21/10/2019
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