8.la) (Sees WH GI asx: aafeda faacr-ot ay to oe PERSONAL PARTICULARS FORM ga roe & aie F He) (in Duplicate) Woe Corea at eT TY) Full name [Expanded initials) ...... (SF) (Surname) (FT) (Nama) feT/Sex FRY Male, Fil/Female @ wanes 3 we HH eT aT aaa et? (a) Has the applicant ever changed his/her name? (@) wea, ve a Byes 7/No (b) yes, previous name : z v Een ate ie bi om fofer Date of Birth Date = Month Year ‘FT RT/Piace of Birth .. We/Town. ‘Ws7/State. BIEETA/ Profession (la) PRA/ Father: oss (SE) (Sumamn (B/b)FTA/Mother (SFA) surname), ie (SAF) (Surname) eat TI/ Permanent Address WAM # FH/./House NameiNo. .. ‘Tia/TeH/ Vill, Street BFHY Post Office «.... Yfet AAI/Police Station fare Distt WH/state .... ‘eT T/Tel. No. fit FE/Pin Code: (ic) SRV TH/Spouse. 8.(b) Dist... .. fi BIS/Pin Code APD Nemed (A) Name) (FP) Namo) ‘GHIA Tal/Presont Addross : Wart 3 AW/A /House NameiNo. Tia/AeAY Vill Street ‘SIBAY Post Office .. PTT AF Police Staion Frais. WV State shenseees 2a G./Tel, No. 197 8TS/Pin Code WeRR Residing since . _ARATEY Date)n 12 ofe sae Free oe ab) Hen T eT a Sa RETA, STS BA a a Sh aay oe ee orate dha we ore Ue es Stated ea fee ar ae Te ea & Aafaae fee ws aT OH aafatees 2 (et ah at wre) aT TU Fe Sees Be fore dae fear va wel aT seer a If the applicant has not resided at the address given against para 6{b) Continuously for che last one year, please furnish the other addresstes) with duration whors ho/she has resided during tha period. Applicant should furnish an additional set of Personal particulars form (in duplicate with photograph) for each addi- tional place of stay during the last one year. PP form maybe photocopies fer the purpose. Werom AFI To .. (PATRI Date) BV From seers TT O corse aT A AH//House Name/No. SHH AHVA./ House Name/No, ‘rfayTeH/ Vill. Street. AAR TRH/ Vill Sweet. ‘ETEHY Post Office . ‘STRAY Post Otfice TRH ATAT/Poliee Station YHA TA/Police Station FARI/Distt. Fret/ Dist. . WE State session (fe=1#/Dat6) TEV State vss fi ATE/Pin code ft BIS/Pin code SqTHT H/Tel, No... TRA T.ITel No cies eds st as & a fede et am he ah 8 at ane sora & Sa BH References :- Names and Addresses at two responsible nersons in the applicant's locality who.can vouch for the applicant. (1) FH/Name “Wa/ Address (1) 3TR/Name .. ‘Wol/Address aa F/Tel. No. 2 Waits FAaV/ Physical Particular (@/a) wraTs/ Height wees EV, (@) sie aor at am {b) Colour of eyes ..-...+ re, [c) Colour of hair ...... (8) Wear a ree Pre |d) Visible distinguishing mark .... aaah ATT A ATTIC S Applicant is a citizen of India by : aH A./Tel, No. Bat /em, sat Fg SCT irec ae Birth Descent Registretion _Naturaisation aig vee TIE ae Sea 8 ETT sa Te Furnish details of previous paseportitravel document, if anyi ()-watié ¥eA/Passport Number Gi) 37 BF AT FTE/Date of Issue : (ii) 58 BF FT SIF/Place of Issue. 5.1 (iv) Baie & aTTE/ Date of Expiry : ange vengt stem aye at aa (Get ae ate at faa ait vicar S weve H and era & sigs art faa) Signature or Thumb Impression of the applicant (Left hand T.l. of male and Right hand T.1. of female)