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‘Aeplicaion Form
2 PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Application Reference Number
‘Applying For
‘Type of Application
‘Type of Passport Booklet
Applicant's Name
Date of Birth (DDIMMIYYYY)
Validity Required
Place of Birth (Village/Town/City)
District
State/UT
County
Gender
Marital Status
Citizenship of India by
PAN
Voter id
Employment Type.
Is either of your parent (in case of minor)/spouse, @
‘government servant?
Educational Qualification
‘Are you eligible for Non-ECR category?
‘Aadhaar Number
Father's Name
Mother's Name
Residing Since(MMIYYYY)
Address.
PIN
Mobile/Tel No.
E-mail
Address
PIN
Mobile/Tel No.
Name and Address
Mobile/Tel No.
E-mail
1.Aadhaar Cardi€-Aadhaar
2.Aadhaar Card
18-10036291
FRESH
NORMAL
JUMBO
SOMASHEKHARA SHRISHAILA PATTANASHETTI
20/07/1995
NA
GANI
\VWAYAPURA
KARNATAKA,
INDIA
MALE
SINGLE
BIRTH
CKAPP7135H
XHY2782860
NOT EMPLOYED
N
GRADUATE AND ABOVE
Y
235613545922
‘SHRISHAILA TIPPANNA PATTANASHETTI
KAMALA SHRISHAILA PATTANASHETTI
o7iig9s
ATIPOST.GANI T:BASAVAN BAGEWADI, GANI, NIDAGUNDI,
\VWAYAPURA, KARNATAKA,
586201
8884156649
‘SPSOMASHEKHAR2170@GMAIL.COM
ATIPOST.GANI TO:BASAVAN BAGEWADI, GANI, NIDAGUNDI
\VWAYAPURA, KARNATAKA,
586201
8884156649
‘SOMASHEKHARA PATTANASHETTI
8884156649
‘SPSOMASHEKHAR2170@GMAIL.COM
lowe allegiance to the sovereignty, unity and integrity of India, and have not voluntarily acquired citizenship or travel document of
any other county. | 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 rue and | am solely responsible for its accuracy, and | am liable to be penalized or prosecuted
iffound otherwise. lam aware that under the Passports Act, 1967 itis a criminal offence to furnish any false information or to
suppress any material information with a view to obtaining passport or travel document.
Place
Date
BENGALURU
o7iaz018
hips: portal2 passpartinda.govinlAppOnlineProjectlsecuralApplicartSelfDeclarationAction "