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PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 17-0010021494
Applying For REISSUE
If Re-issue, specify reason(s) VALIDITY EXPIRED WITHIN 3 YEARS/DUE TO EXPIRE.
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name PRATIKSHA SHEKHAR KALE
Date of Birth (DD/MM/YYYY) 14/09/1999
Validity Required 10 Years
Place of Birth (Village/Town/City) MUMBAI
District MUMBAI
State/UT MAHARASHTRA
Country INDIA
Gender FEMALE
Marital Status SINGLE
Citizenship of India by BIRTH
Employment Type STUDENT
Is either of your parent (in case of minor)/spouse, a
Y
government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Family Details
Father's Name SHEKHAR LAXMAN KALE
Mother's Name ANJALI SHEKHAR KALE
Father/Legal guardian's File/Passport Number G9422135
Mother/Legal guardian's File/Passport Number J9045969
Present Residential Address Details
Residing Since(MM/YYYY) 09/2000
4-14, 1ST FLOOR, B P T COLONY SAGAR GEET NAGAR, WORLI VILLAGE,
Address
DADAR, MUMBAI, MAHARASHTRA
PIN 400030
Mobile/Tel No. 9769214999
E-mail KALEPRATIKSHA1499@GMAIL.COM
VEENA SHIRSAT 4-7 B P T COLONY SAGAR GEET NAGAR WORLI VILLAGE
First Reference Name And Address
MUMBAI 400030
VARSHA WAGHELA 4-3 B P T COLONY SAGAR GEET NAGAR WORLI VILLAGE
Second Reference Name And Address
MUMBAI 400030
Permanent Residential Address
B-503 GULMOHAR CHS KALE GURUJI MARG, DADAR WEST, DADAR, MUMBAI,
Address
MAHARASHTRA, INDIA
PIN 400028
Mobile/Tel No. 9769214999
Emergency Contact Details
ANJALI SHEKHAR KALE 4-14 1ST FLOOR B P T COLONY SAGAR GEET NAGAR
Name and Address
WORLI VILLAGE MUMBAI 400030
Mobile/Tel No. 9819414999
E-mail KALEPRATIKSHA1499@GMAIL.COM
Previous Passport/ Application Details
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number K8174785
Date of Issue 17/01/2013
Date of Expiry 13/09/2017
Place of Issue MUMBAI