1/7/2020 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 20-1000250305
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet JUMBO
Applicant Details
Applicant's Name MARIA MOHAN
Date of Birth (DD/MM/YYYY) 13/06/1997
Validity Required NA
Place of Birth (Village/Town/City) BENGALURU
District BENGALURU
State/UT KARNATAKA
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
N
government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark TWO MOLES ON LEFT HAND
Aadhaar Number 856346661615
Family Details
Father's Name MOHAN GEORGE
Mother's Name REENA MOHAN
Present Residential Address Details
NO.3.4TH CROSS, BANASWADI ROAD EXTN, M S NAGAR, BENGALURU,
Address
BENGALURU, KARNATAKA
PIN 560033
Police Station BANASWADI
Mobile/Tel No. 8861426735 / 08025463115
E-mail MARIAMOHAN97@GMAIL.COM
Permanent Residential Address
NO.3.4TH CROSS, BANASWADI ROAD EXTN, M S NAGAR, BENGALURU,
Address
BENGALURU, KARNATAKA
PIN 560033
Police Station BANASWADI
Mobile/Tel No. 8861426735 / 08025463115
Emergency Contact Details
MOHAN, NO. 3, 4TH CROSS, BANASWADI ROAD EXTN, M S NAGAR,
Name and Address
BANGALORE-560033
Mobile/Tel No. 9845735415 / 08025463115
E-mail ROSEDTPCENTRE@GMAIL.COM
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 BENGALURU
Date 07/01/2020

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