INSTRUCTIONS

HELP US TO SERVE YOU BETTER BY FILLING THE FORM STRICTLY AS

PER THE FOLLOWING INSTRUCTIONS

Use capital letters only.

Use Black/ Blue ball pen only.
Dont fill the form with pencil or ink-pen.
Write clearly within the box without touching the boundaries.
Adjust the information to fit within the number of boxes provided.
Do not write anything outside the box.
Avoid over-writing.
Signature should be strictly within box without touching the boundaries.
Photograph should be manually cut so as to fit exactly in the box
provided and at least full face should be retained.
In case of Male/ Female option, mark [] only in the relevant box.
In case of long name the convention demonstrated in the following
example should be adhered to scrupulously.
Example:
Name: Karur Vaikunta Subramaniyan Ramanathan Pillai
Actually the above name should have been split as follows:
Surname: Pillai
Given name: Karur Vaikunta Subramaniyan Ramanathan
Since the length of the given name is more than 30 characters, it should be entered in the
following way:
Surname:

P I L L A I

R AM A N A T H AN

Given name:

K A R U R

V A I K U N T A

S U B R A M A N I Y A N

 SE {j / INDEX CARD
+nE u c +I VB / To be filled by applicant in BLOCK LETTERS
1. { x (/i/E ) Full Name (Mr./Mrs./Miss):i. +nE/ Applicant .............................................................................................
ii. {i / Father ...................................................................................................
iii. i / Mother ..................................................................................................
iv. {i/{ix / Spouse .......................................................................
(+nE BE ]) (35
45 0 0) S{EB +
2. l {i / Permanent Address ............................................................
+nE E +v iI ]
..................................................................................................
..................................................................................................

..........................................................................................
3. {Sx ESx /Visible distinguishing marks ..............................................
4. Vx lx /Place of birth .......................................................................

{ + +v +nx {j {
x SB*
Applicant must paste
(35 45 mm) one photograph here with half
the signature on the
photograph and half on
the card.

5. Vxil / Date of birth ........................................................................

6. { / Profession ......................................................................................................
7. { x { {]x0 / Previous Passport No. .............................................................
8. V E x Ei J / Date of issue ...............................................................................
9. V E x E lx / Place of Issue ................................................
10.

xxE iI / Specimen Signature .....................................................................

E E | M E B
For Official Use Only

n/ < x0
Ref.

1. { {]x0

File

No..........................................

2.

Passport No....................................

V E xEi J
Date of Issue........................

2. V E x E lx
Place of Issue....................................

3. E i/]{{h
Observation Remarks.................................

4. n n M< B
Subsequent services....................................

{. B. .
............................... P.A.C.

]. +. + .
............................... T.O.R.

B . ]. B .
............................... F.T.S.

 i E
GOVERNMENT OF INDIA

Ij { {]E / REGIONAL PASSPORT OFFICE

{i {j / ACKNOWLDEGEMENT
+{E +nx {j, E B xx Ji +x n iVE l |{i +* +{E n
J ...............* nxE .................... * E{ {UiU E i < EbE l +l
n J J*
Received your application form alongwith ............................ fee and other documents
mentioned below. Your reference No. is ..*................................ Dated ..................................
Please bring this card or quote this reference for enquiries.

iI / Signature

Ei Ij { {]+vE / For Regional Passport Officer

|{i n iVE h / Details of documents received:
1. E b}] / Bank Draft:
/ Amount .................. J / Number .................... nxE / Date ..................
2. ]O E J / No. of photographs
3. { x { {], n E</ Old Passport, if attached
4. E | M E B / For Official Use

*
*
*

i E E l
O.I.G.S.
]
/i/E
Sh/Smt./Kum. ......................................................................................................................

Ex J B M
House No. & Street .............................................................................................................

M B { ]
V.P.O. ..................................................................................................................................

B V
Town & State ......................................................................................................................

{x Ec
PIN Code .............................................................................................................................

x: E

i E

Serial No. PPT/99

FREE OF CHARGE

FORM NO. 1

GOVERNMENT OF INDIA

n j
MINISTRY OF EXTERNAL AFFAIRS

{ {]+nx {j
PASSPORT APPLICATION FORM

( x { xn vx{E {g)
(Read Instructions Carefully Before filling the Form)

(+nE BE ]) (35 45
0 0) S{EB + +nE
E+v iI ]{ + +v
+nx{j{ xSB*
Applicant must paste (35
45 mm) one photograph
here with half the signature on the photograph and
half on the application.

(E{ c+I )
(PLEASE FILL IN BLOCK LETTERS)
xE n

E b}]

Mix E M< ................ {

Amount of fee paid Rs. ...............

Cash
Bank Draft
Bank Draft No.............................................
Bank's Name ................................................

E b}] 0 .........................................
E Ex...................................................
1.

{ x (+tI E | M x E )
Full name (Expanded initials)
(i) +nE / Applicant ...................................................................................................................................
(={x) (Surname)
(x) (Name)
(ii) {i / Father ...........................................................................................................................................
(={x) (Surname)
(x) (Name)
(iii) i / Mother ........................................................................................................................................
(={x) (Surname)
(x) (Name)
(iv) {i/{ix / Spouse ..................................................................................................................................
(={x) (Surname)
(x) (Name)

2.

3.

Male

Female

i J

Date

Month

Year

M / Sex

Vx il / Date of Birth

Vx lx / Place of Birth ...............................................................................................................................

V / Distt.
V / State
5. {Sx E |E] Sx / Visible distinguishing mark: ..............................................................................................
6. {i / Address:
(1) i l {i / Permanent Address in India:
(2) ix {i / Present Address :
E ? /Residing since ........... (nxE / Date)
Ex x/x0 / House Name/No. ............................
Ex x/x0 / House Name/No. ...........................
M/M / Vill./Street .............................................
M/M / Vill./Street ............................................
bEP / Post Office ................................................
bEP / Post Office ...............................................
{ lx / Police Station .....................................
{ lx / Police Station ....................................
V / Distt. .........................................................
V / Distt. .........................................................
V / State ...........................................................
V / State ..........................................................
{x Eb / PIN Code
{x Eb / PIN Code
] x 0 / Tel No. ..............................................
] x 0 / Tel No. ..............................................
1
4.

7.

n + nE xn E { (6) nB MB {i { Mi n x i, E{ =x lxE {i + +v nV
< +v Enx / If the applicant has not resided at the address given against para (6) continuously for
the last two years. Please furnish the other address(es) with duration where he/she has resided during the
period.

/From........................ iE/to ..........................(nxE/Date) / From ........................ iE/to ..............(nxE/Date)

Ex x/x0 / House Name/No. ............................
Ex x/x0 / House Name/No. ...........................
M/M / Vill./Street .............................................
M/M / Vill./Street ............................................
bEP / Post Office ................................................
bEP / Post Office ...............................................
{ lx / Police Station .....................................
{ lx / Police Station ....................................
V / Distt. .........................................................
V / Distt. .........................................................
V / State ...........................................................
V / State ..........................................................
{x Eb / PIN Code
{x Eb / PIN Code
] x 0 / Tel No. ..............................................
] x 0 / Tel No. ..............................................
8.

/ Profession ......................................................................................................................................
+M E /{0B 0 0 ES i +x{i |h {j Mx E /If Govt./PSU Employee, attach NOC

9.

IE M i / Educational Qualifications : ......................................................................................................

10. (i) +nE i E xM E / Applicant is a citizen of India by:

Vx

xMi

{VE h u

n E h u

Birth

Descent

Registration

Naturalisation

(ii) E +x n E xM Ei i h n / If the applicant ever possessed citizenship of any other country give
details
11. C +nE x { E +{x x n , i = E h n(xn E { 7 nJ) / If the applicant ever changed his/her
name, give details : (See para 7 for instructions)
....................................................................................................................................................................
12. C +nE x { E { {]/ j n iV = E B +nx E l? i E{ = E n* / The details of
passport/travel document held/applied for, if any:
(i) { {]E < x0 / Passport Office File Number: ..............................................................................
(ii) { {]/ j n iV J / Passport/Travel Document Number ................................................................
(iii) V x E i J / Date of Issue/Application: ..........................................................................................
(iv) V x E lx / Place of Issue/Application ...........................................................................................
(v) C { {]v ? / Whether Passport valid?

Yes/No

/x
13. C + n E '=i| x VS + E x ' E {j ? +M i n i V E | hi |i {

M< (xn E { 4 nJ )
Is applicant entitled for "Emigration Check Not Required (ECNR)?" If Yes, attach attested

Yes

Yes

No

copy of the document (see para 4 of instructions)

14. C < v V ?
Whether the passport contains valid visas?

No

15. E{ iB E C
Please Indicate whether :
(i) E +{E { {]/ j n iV nx x E M l +l i=xE E M l
(i) A passport/travel document was refused/impounded at any time or restored
conditionally.
(ii) +nE E E Mi { n |i ii E M l
(ii) The Applicant was repatriated at Government cost.
(iii) C +nE E E |i ii E M l
(iii) The applicant was ever deported to India.

Yes
No

Yes

Yes

Yes

Yes

Yes

No

No

16. { {]+vx , 1967 E v 6 E +xiMi +{Ii VxE

Information required under section 6 of the Passport Act, 1967
(i) C +nx {j E i J E `E {S { E +v E +{ vE V E B

E i E E x u +nE E n ` M l + E E V
n M<l?
(i) Has the applicant 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 criminal offence and
sentenced to imprisonment?
(ii) C i E E Vn +n i +nE E r E<En S ?
(ii) Are any criminal proceedings pending against the applicant before a court in India?

No

No

(iii) C E x u x { x E h], x +l M ~i E h] / i E

Vx E x E +n V EB M ?
(iii) Has a warrant or summons for appearance or warrant for arrest or an order prohibiting the
applicant's departure from India been issued by a court?
17.

No

+nE E Ph :
DECLARATION OF APPLICANT :

Z i E |i, BEi + +Jbi E |i x` + x SU E +x n E xM Ei { i M x J<, x Z

E Si E M *
I owe allegiance to the sovereignty, unity & integrity of India and have not voluntarily acquired the citizenship or
travel document of another country. I have not lost, surrendered or been deprived of citizenship of India.

x V VxE n + = E i i E { i Vn * Z < i E VxE E { {]/n iV

E Z` VxE nx/U{x +{ v *
The information given by me is true and I am solely responsible for its accuracy. I am aware that it is an offence under
the Passports Act 1967 to furnish any false information or to suppress any material information with a view to
obtaining passport or any other travel document.

....................................................................

+nE E iI /+M` E x x
Signature/Thumb Impression of applicant

i J/ Date .......................... lx/ Place ........................

18. x M E li i/{i { {]E xx Ji VxE n
In case of minors, following passport particulars of both parents must be given:

i / Mother

{i / Father

(a) { {]x0 / Passport No:

..................................

..............................

(b) V x E i J / Date of Issue:

..................................

..............................

(c) V x E lx / Place of Issue:

..................................

..............................

CiE h - {j
19. n { {]+ E Ci E i i {i +l +E E Ph (i B {i +l +E iI E )
Declaration of Parents or Guardians if Passport is for minor : (To be signed by both Parents or Guardians)

{] E i E ={ Ci E (x) ............................................... {j/{j i

.............................................. ............................................... V E i {i/+ E E v *
= E { JS=`x E Vn E Sx i * x`{E Ph E i E = x E +{x xM Ei x J<, = E
{ i M x E + x = < E Si E M + < +nx {j = E v n M<VxE *
We affirm that the particulars given above are in respect of (Name) ........................................................................ son/
daughter of Smt. ............................................................................. Sh. ...................................................................... of whom we
are the Parents/Guardians. We undertake the entire responsibility for his/her expenses. We solemnly declare that he/she
has not lost, surrendered or been deprived of his/her citizenship of India and that the information given in respect of him/
her in this application is true. It is also certified that the name of the child mentioned is not included in Passport of either
parent.

i B {i/+E E iI /+M` E x x
({ E B + j E nB l E +M` E x x)
Names & Signatures/T.I. of Parents/Guardians
(Left hand T.I. if male and Right hand T.I. if female)
lx/ Place ................................... nxE / Date..............................
20. i +l nP]x Vx E li = Ci E h

V Si E Vx :

21. Mx {j
Enclosures:

Particulars of person to be intimated in the event

of death or accident

x / Name ...........................................................
{i / Address .......................................................

...............................................................................

...........................................................................

...............................................................................

n / Telephone Number....................................

...............................................................................

...............................................................................

21. +nE xS J lx+ ]E { E{ iI +l +M` E x x E n-n xxn*

Specimen signatures or Thumb Impressions of applicant in the boxes given below AND on two stickers.

E | M E
For Office Use

22. Specimen signature (using Ball Point Pen) or Thumb Impression of applicant in the
boxes given below and on the two stickers. Two clear photographs (without
signature) may also be pasted below:

Specimen Signature

Specimen Signature

For Office Use

CiE h-{j
PERSONAL PARTICULARS FORM

(n |i )

Applicant must paste (35

45 mm) one photograph
here with half the signature on the photobgraph
and half on the application.

(IN DUPLICATE)
1.

(+nE BE ]) (35
45 0 0) S{EB
+ +nE E +v
iI ] { + +v
+nx {j { x SB*

{ x (+tI E | M x E )
Full Name (Expanded initials) ..........................................................................................................................

(={x) (Surname)
2.
3.

(x) (Name)

M / Sex
{ / Male

j/ Female

/ Yes

x / No

(E) C +nE x { E +{x x n ?

(a) Has the applicant ever changed his/her name?

(J) n i { x :
(b) If yes, previous name: .............................................................................................................................

4.

Date

Month

Year

Vx il :
Date of birth :

5.

i J

Vx lx / Place of birth .................................................................................................................................

/ Town......................................................... V / Distt. ....................................................................
V / State ......................................................... {xEb / PIN CODE

6.

(E a)

{i / Father .....................................................................................................................................
(={x) (Surname)
(x) (Name)

(J b) i / Mother ...................................................................................................................................

(={x) (Surname)
(M c)

7.

(x) (Name)

{i/{ix / Spouse ............................................................................................................................

(={x) (Surname)
(x) (Name)

ix {i / Present Address
Ex E x / x0 / House Name/No. ..........................................................................................................
M /M / Vill./Street ..................................................................................................................................
bEP / Post Office .....................................................................................................................................
{ lx / Police Station ..........................................................................................................................
V / Distt. ..............................................................................................................................................
V / State ........................................................................ {x Eb / PIN Code
] x 0 / Tel No. ...................................................................................................................................
5

8.

n +nE xn E { (7) nB MB {i { Mi Mi n x i, E{ =x lxE {i + +v nV < +v

E nx * +nE B |i E +i Ci lx E B V / CiE h {j E BE +i Ci ] ( ] M n |i)
V E * < =q E B CiE h {j E ] E{ E *
If the applicant has not resided at the address given against para (7) continuously for the last two years, please
furnish the other address(es) with duration where he/she has resided during the period. Applicant should furnish
an additional set of Personal particulars form (in duplicate with photograph) for each additional place of stay
during the last two years. PP form may be photocopied for the purpose.

/From........................ iE/to ..........................(nxE / Date) / From ........................ iE/to ..............(nxE/Date)

Ex x/x0 / House Name/No. ...................................
Ex x/x0 / House Name/No. ...........................
M/M / Vill./Street ....................................................
M/M / Vill./Street ............................................
bEP / Post Office .......................................................
bEP / Post Office ...............................................
{ lx / Police Station ............................................
{ lx / Police Station ....................................
V / Distt. ................................................................
V / Distt. .........................................................
V / State ..................................................................
V / State ..........................................................
{x Eb / PIN Code ................
{x Eb / PIN Code .........
] x 0 / Tel No. .....................................................
] x 0 / Tel No. ..............................................
9.

n:- +{x Ij E n Vn Ci E x + {i nV +{E Vxi Ei *

References:- Names and Addresses of two responsible persons in the applicant's locality who can vouch for the
applicant.

x / Name ..........................................
{i / Address .......................................

2. x /Name ...............................................................

...........................................................

...............................................................................

...........................................................

...............................................................................

] x x0 / Telephone No. ....................

] x x0 /Telephone No. ..............................................

{i /Address ............................................................

10. E 0 / Physical Particulars:

(E/a) </ Height ....................... ] /m ................. 0 0 /cm.

(J) +JE M

(M) E M

(b) Colour of eyes .....................................

(C) Colour of hair .........................

(P) {Sx E |E] Sx

(d) Visible distiguishing mark .........................................................................................................
11. +nE i E xM E ?
Applicant is a citizen of India by:

Vx

xMi

{VE h u

n E h u

Birth

Descent

Registration

Naturalisation

12. (E) n { E { {]/ j n iV i E{ = E n*

(a) Furnish details of previous passport/travel document, if any
(i) { {] J / Passport Number ..................................
(ii) V x E i J / Date of issue ...................................
(iii) V x E lx / Place of issue ...................................
(iv) {i E i J / Date of Expiry ..................................
........................................................

i B {i/+E E iI /+M` E x x
({ E B + j E nB l E +M` E x x)
Signature or Thumb Impression of the
applicant (Left hand T.I. of male and
Right hand T.I. of female)

CiE h-{j
PERSONAL PARTICULARS FORM

(n |i )

Applicant must paste (35

45 mm) one photograph
here with half the signature on the photobgraph
and half on the application.

(IN DUPLICATE)
1.

(+nE BE ]) (35
45 0 0) S{EB
+ +nE E +v
iI ] { + +v
+nx {j { x SB*

{ x (+tI E | M x E )
Full Name (Expanded initials) ..........................................................................................................................

(={x) (Surname)
2.
3.

(x) (Name)

M / Sex
{ / Male

j/ Female

/ Yes

x / No

(E) C +nE x { E +{x x n ?

(a) Has the applicant ever changed his/her name?

(J) n i { x :
(b) If yes, previous name: .............................................................................................................................

4.

Date

Month

Year

Vx il :
Date of birth :

5.

i J

Vx lx / Place of birth .................................................................................................................................

/ Town......................................................... V / Distt. ....................................................................
V / State ......................................................... {xEb / PIN CODE

6.

(E a)

{i / Father .....................................................................................................................................
(={x) (Surname)
(x) (Name)

(J b) i / Mother ...................................................................................................................................

(={x) (Surname)
(M c)

7.

(x) (Name)

{i/{ix / Spouse ............................................................................................................................

(={x) (Surname)
(x) (Name)

ix {i / Present Address
Ex E x / x0 / House Name/No. ..........................................................................................................
M /M / Vill./Street ..................................................................................................................................
bEP / Post Office .....................................................................................................................................
{ lx / Police Station ..........................................................................................................................
V / Distt. ..............................................................................................................................................
V / State ........................................................................ {x Eb / PIN Code
] x 0 / Tel No. ...................................................................................................................................
7

8.

n +nE xn E { (7) nB MB {i { Mi Mi n x i, E{ =x lxE {i + +v nV < +v

E nx * +nE B |i E +i Ci lx E B V / CiE h {j E BE +i Ci ] ( ] M n |i)
V E * < =q E B CiE h {j E ] E{ E *
If the applicant has not resided at the address given against para (7) continuously for the last two years, please
furnish the other address(es) with duration where he/she has resided during the period. Applicant should furnish
an additional set of Personal particulars form (in duplicate with photograph) for each additional place of stay
during the last two years. PP form may be photocopied for the purpose.

/From........................ iE/to ..........................(nxE / Date) / From ........................ iE/to ..............(nxE/Date)

Ex x/x0 / House Name/No. ...................................
Ex x/x0 / House Name/No. ...........................
M/M / Vill./Street ....................................................
M/M / Vill./Street ............................................
bEP / Post Office .......................................................
bEP / Post Office ...............................................
{ lx / Police Station ............................................
{ lx / Police Station ....................................
V / Distt. ................................................................
V / Distt. .........................................................
V / State ..................................................................
V / State ..........................................................
{x Eb / PIN Code ................
{x Eb / PIN Code .........
] x 0 / Tel No. .....................................................
] x 0 / Tel No. ..............................................
9.

n:- +{x Ij E n Vn Ci E x + {i nV +{E Vxi Ei *

References:- Names and Addresses of two responsible persons in the applicant's locality who can vouch for the
applicant.

x / Name ..........................................
{i / Address .......................................

2. x /Name ...............................................................

...........................................................

...............................................................................

...........................................................

...............................................................................

] x x0 / Telephone No. ....................

] x x0 /Telephone No. ..............................................

{i /Address ............................................................

10. E 0 / Physical Particulars:

(E/a) </ Height ....................... ] /m ................. 0 0 /cm.

(J) +JE M

(M) E M

(b) Colour of eyes .....................................

(C) Colour of hair .........................

(P) {Sx E |E] Sx

(d) Visible distiguishing mark .........................................................................................................
11. +nE i E xM E ?
Applicant is a citizen of India by:

Vx

xMi

{VE h u

n E h u

Birth

Descent

Registration

Naturalisation

12. (E) n { E { {]/ j n iV i E{ = E n*

(a) Furnish details of previous passport/travel document, if any
(i) { {] J / Passport Number ..................................
(ii) V x E i J / Date of issue ...................................
(iii) V x E lx / Place of issue ...................................
(iv) {i E i J / Date of Expiry ..................................
........................................................

i B {i/+E E iI /+M` E x x
({ E B + j E nB l E +M` E x x)
Signature or Thumb Impression of the
applicant (Left hand T.I. of male and
Right hand T.I. of female)