272, 9:34 PM \View:Prnt Submited Form File Number (For Office Use Only) GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS PASSPORT APPLICATION FORM Please read the Passport Instruction Booklet carefully before filing the form. Fill this form in CAPITAL LETTERS using blue/black ink ball point pen only. Furnishing of incorrect information’ suppression of information would lead to rejection of the application and would attract penal provisions as prescribed under the Passports Act, 1967. Please produce your original documents at the time of submission ofthe form, ‘Application Reference Number 22-0012369082 ‘Applying For REISSUE VALIDITY EXPIRED WITHIN 3 IFReissue, specity reason(s) YEARSIDUE TO EXPIRE. Seaameasyes ‘Type of Application NORMAL unsignes recent color photogroph of 325 ‘Type of Passport Booklet NORMAL ean oben Applicant's Name PRATHMESH RAMDAS RITHE Date of Birth (ODIMMIYYYY) 04/02/2003, Validity Required NA Place of Birth (VillagerTown/City) PUNE District >)00/ ) © State/UT MAHARASHTRA ‘Signature/Left Hand Thumb Impression of literate Applicant and Minors wo Region/County INDIA ‘cannot sign. Gender MALE Marital Status SINGLE Citizenship of India by BIRTH PAN FCYPRSSS6K Employment Type STUDENT Is either of your parent (in case of minor)/spouse, a government servant? Educational Qualification 10TH PASS AND ABOVE ‘Are you eligible for Non-ECR category? ‘Aadhaar Number 560666803206, Father's Name RAMDAS GULABRAO RITHE Mother's Name SEJAL RAMDAS RITHE hitpssportalt passportnela. gov n/AppOnlineProjectisecurelViewDrattAction?ar272, 9:34 PM Address PIN Police Station Mobile/Tel No, E-mail Address PIN Police Station Mobile/Tel No, Name and Address Mobile/Tel No. E-mail Passport Number Date of Issue Date of Expiry Place of Issue File Number Mode of Payment Date Receipt/Reference No ‘Amount Received (Rs.) ‘PAN Card issued by the Income Tax Department 2.Electicity Bill \View:Prnt Submited Form RHNO.K1/6,PRINCESS VILLA.JAl GANESH SAMRAJYA, BHOSARI, >}©@/ ) ©, MAHARASHTRA 411039 BHOSAR! MIDG 7722050017 PRATHMESHRITHE@GMAIL.COM RHNOK1/6,PRINCESS VILLA.JAI GANESH SAMRAYA, BHOSARI,>}@6/ ) ©, MAHARASHTRA 411039 BHOSARI MIDC 722050017 ‘SEJAL RAMDAS RITHE, JAI GANESH SAMRAJYA, 9973672772 SEJALRITHE@GMAIL.COM 2096389 18/08/2015, ‘7108/2020 PUNE PNtoss60 1980415 DebiviCredit Card orvosi2022 cpaaxzDeye 1800.00 (ONE THOUSAND FIVE HUNDRED ONLY) | owe allegiance to the sovereignty, unity & integrity of India, and have not voluntarily acquired citizenship or travel document of any ‘ther country, | have not lost, surrendered or been deprived of the citizenship of India, | have not contravened any of the conditions relating to the possession and use of an Indian passport. | affirm that the information and particulars given by me in this form are true and correct. | further state that | am not suppressing ‘any material information in this regard, | further affirm that the enclosures and documentary proof submitted in support of my application for an Indian passport are authentic and solely pertain to me and am fully responsible for the accuracy of the same. | ‘am liable to be penalized or prosecuted if found otherwise. | am aware that under the Passports Act, 1967 it is a criminal offence to {urmish any false information or to suppress any material information with a view to obtaining passport or travel dacument. hitpssportalt passportnela. gov n/AppOnlineProjectisecurelViewDrattAction?ar 2-0012360062 20272, 9:34 PM \View:Prnt Submited Form | have read and understood the contents of the above and by submitting this form certify that all the information submitted by me in the form is bonafide. Place PUNE ‘Signature/Left Hand Thumb Impression of Applicant (if applicant is minor, either parent Date o1vosr2022 to sign) hitpsiportalt passportincia. gov.n/AppOnIneProjectsecure/ViewDraftAction?ar=22-0012360062 ag