8/20/13

Application Form

Passport Application Government of India, Ministry of External Affairs Online Application Receipt
Applicant Details : Application Reference No 13-1007926837 Batch 5 Service Type REISSUE Type of Application Normal Sequence No. 13 Application Submitted Date20/08/2013 Date of Birth 15/10/1964 Reporting Time 10:15 AM Gender MALE Employment Type PRIVATE Marital Status MARRIED Place of Birth AVALA,KOZHIKODE RURAL,KERALA Given Name AZEEZ Surname THARAVATTATH Father's Name MOIDEEN KALOTH KANDY Mother's Name KUNHAMI Spouse's Name HAJARA KULANGARA Present Address OLOTH HOUSE,AVALA(PO),, MEPPAYUR VIA, KOZHIKODE RURAL - 673524, KERALA, INDIA Applicants References : First Reference Details NARAYANAN.N,NAGATH,AVALA(PO),MEPPAYUR(VIA),KOZHIKODE 673524 Second Reference Details SREEJITH,AVALA(PO),MEPPAYUR(VIA),KOZHIKODE 673524 Previous Passport Details : Old Passport No. E6104355 Passport Issue Date 19/08/2003 Passport Expiry Date 18/08/2013 Place of Issue KOZHIKODE # Payment Details: Total Fee (Rs.) 1500.00 Paid Fee (Rs.) 1500.00 Date and Time 20/08/2013 12:49 PM Transaction Id IGL2119217 Appointment Details : Kozhikode, KOYENCO HOUSE, WEST HILL PSK Location CHUNGAM, KANNUR ROAD, KOZHIKODE - 673005 Date & Time of 21/08/2013 & 10:30 AM Appointment Appointment ID 100004654112813 Reporting Time 10:15 AM
Note: Applicant should reach the Passport Seva Kendra by the reporting tim e m entioned above for pre-checking of docum ents to avoid any hassles in issuance of token. Only in the case of Senior Citizens, Physically Challenged, Illiterate Applicants and Minor cases, one accom panying person from the fam ily w ill be allow ed along w ith the applicant. Applicant w ill not be issued token at Passport Seva Kendra, if they report after scheduled appointm ent tim e. Minor applicants below 4 years of age need to carry a recent coloured passport size (4.5 x 3.5 cm ) photograph w ith a w hite background w hile visiting Passport Seva Kendra. Other applicants need not carry any photograph as photograph w ill be captured at the Passport Seva Kendra. Carrying of corrosive substances or explosives, arm s or any sharp objects w hich m ay cause physical harm or violence are prohibited inside the PSK. Electronic item such as cam era is prohibited inside the PSK.

# Details as per the Payment Date. Payment once made for availing passport services will not be refunded.

https://portal2.passportindia.gov.in/AppOnlineProject/secure/openPdfForApplReciept

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