6/29/2014 Application Form

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Passport Application
Government of India, Ministry of External Affairs
Online Application Receipt
ATM facility available at PSK
for all Bank Cards
Applicant Details:
Application Reference No. 14-1005557411
Batch 11
Sequence No. 2
Reporting Time 11:45 AM
Service Type REISSUE
Type of Application Tatkaal
Application Submitted Date 29/06/2014
Date of Birth 05/08/1984
Gender FEMALE
Employment Type HOME MAKER
Marital Status MARRIED
Place of Birth RAJAHMUNDRY,EAST
GODAVARI,ANDHRA
PRADESH
Given Name INDIRA PRIYADARSINI
Surname MARELLA
Father's Name SATYANARAYANA MARELLA
Mother's Name SATYAVATHI MARELLA
Guardian's Name NOT APPLICABLE NOT APPLICABLE
Spouse's Name SAJAN RADHAKRISHNAN SUJATHA

Present Address 59-4-3, P&T COLONY, RAJAHMUNDRY, EAST GODAVARI, 533105, ANDHRA PRADESH, INDIA
Applicants References:
First Reference Details B.S.N MURTHY,A.V APPARAO ROAD,WHITE HOUSE,RAJAHMUNDRY
Second Reference Details CHIRANJEEVI,P&T COLONY,NEAR BETHAL SCHOOL,RAJAHMUNDRY

Previous Passport Details
Old Passport No. J2329041
Passport Issue Date 06/10/2010
Passport Expiry Date 05/10/2020
Place of Issue VISAKHAPATNAM
Payment Details:
#
Total Fee (Rs.) 3500.00
Paid Fee (Rs.) 1500.00
Date and Time 29/06/2014 07:59 PM
Transaction Id CP07572477

Appointment Details:
PSK Location
Visakhapatnam,
BOTCHA SQUARE, DOOR NO 39-6-71,
KAPPARADA VILLAGE, OPPOSITE
BIRLA JUNCTION, MURALI NAGAR,
VISAKHAPATNAM
Date and Time of Appointment 01/07/2014 & 12:00 PM
Appointment Id 100005612293414
Reporting Time 11:45 AM
Appointment Quota Tatkaal


Thanks for showing your interest in 'Passport Seva SMS Services' enrolment. Please pay Rs 30/- (THIRTY ONLY) in cash as the
Enrolment Charges during your visit to Passport Seva Kendra.

Note:
Applicant should reach the Passport Seva Kendra by the reporting time mentioned above for pre-checking of documents
to avoid any hassles in issuance of token.
Applicant should bring all the originals and one set of photo copy, photo copies should be self attested by the applicant.
One accompanying person from the family will be allowed along with Senior Citizens, Physically Challenged, Illiterate and
Minor applicants only.
Applicant will not be issued token at Passport Seva Kendra, if they report after scheduled appointment time.
Minor applicants below 4 years of age need to carry a recent coloured passport size (4.5 x 3.5 cm) photograph with a white
6/29/2014 Application Form
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background while visiting Passport Seva Kendra. Other applicants need not carry any photograph as photograph will be
captured at the Passport Seva Kendra.
Carrying of corrosive substances or explosives, arms or any sharp objects which may cause physical harm or violence are
prohibited inside the PSK. Electronic item such as camera is prohibited inside the PSK.
Applicants applying under "TATKAAL" scheme may please note that their application processing at Passport Seva Kendra
may take approximately 2 hours due to additional verifications required before processing of such applications. Therefore,
"TATKAAL" applicants are advised to plan their schedule accordingly.
Balance fee (if applicable) after editing the submitted form will be payable in cash at the Passport Seva Kendra.
# Details as per the Payment Date. Payment once made for availing passport services will not be refunded.