PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 20-0000533432
Applying For REISSUE
If Re-issue, specify reason(s) CHANGE IN EXISTING PERSONAL PARTICULARS
If change in existing personal particulars, specify SPOUSE NAME , ADDRESS
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name ARPIT GOYAL
Date of Birth (DD/MM/YYYY) 26/01/1991
Validity Required NA
Place of Birth (Village/Town/City) KHATIMA
District UDHAM SINGH NAGAR
State/UT UTTARAKHAND
Country INDIA
Gender MALE
Marital Status MARRIED
Citizenship of India by BIRTH
Employment Type SELF EMPLOYED
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Family Details
Father's Name VIPIN GOYAL
Mother's Name NEELAM GOYAL
Spouse's Name NEHA GOYAL
Present Residential Address Details
HNO-172MOH-JEEBEE NAGAR NEAR CHAUHAN PETROL PAMP, KHATIMA,
Address
UDHAM SINGH NAGAR, UTTARAKHAND
PIN 262308
Police Station KHATIMA
Mobile/Tel No. 9997304201
E-mail CAFEBLY2020@GMAIL.COM
Emergency Contact Details
Name and Address NEHA GOYAL
Mobile/Tel No. 9997304201
Previous Passport
Details of latest held/existing/lost/damaged Ordinary Passport
Passport Number J2520479
Date of Issue 11/10/2010
Date of Expiry 10/10/2020
Place of Issue DEHRADUN
File Number DDNA02295410
Other Details
Enclosures
1.Aadhaar Card/E-Aadhaar
2.Aadhaar Card/e-Aadhar containing the 12 digit Aadhaar number issued by the Unique Identification Authority of India(UIDAI)
Self Declaration
I owe allegiance to the sovereignty, unity and integrity of India, and have not voluntarily acquired citizenship or travel document of any
other country. I 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 true and I am solely responsible for its accuracy, and I am liable to be penalized or prosecuted if found
otherwise. I am aware that under the Passports Act, 1967 it is a criminal offence to furnish any false information or to suppress any
material information with a view to obtaining passport or travel document.
Place BLY
Date 11/01/2020
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