PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 18-0002705620
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name NIKUNJ KALPESHKUMAR BHATT
Date of Birth (DD/MM/YYYY) 16/07/1997
Validity Required NA
Place of Birth (Village/Town/City) ANAND
District ANAND
State/UT GUJARAT
Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN CJXPB3872K
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
Aadhaar Number 746882570454
Family Details
Father's Name KALPESHKUMAR CHANDRAKANT BHATT
Mother's Name SAPANABEN KALPESHKUMAR BHATT
Present Residential Address Details
Residing Since(MM/YYYY) 07/1997
5189/1,VYAS CHORA,NEAR SANTRAM TEMPLE, UMRETH, UMRETH,
Address
ANAND, GUJARAT
PIN 388220
Mobile/Tel No. 9913303361
E-mail NIKUNJBHATT@LIVE.COM
Permanent Residential Address
5189/1,VYAS CHORA,NEAR SANTRAM TEMPLE, UMRETH, UMRETH,
Address
ANAND, GUJARAT
PIN 388220
Mobile/Tel No. 9913303361
Emergency Contact Details
Name and Address SHREE VRAJDHAM SEVASHRAM, UMRETH-DAKOR ROAD
Mobile/Tel No. 9824279462
E-mail NIKUNJBHATT@LIVE.COM
Other Details
Enclosures
1.Birth Certificate issued by the Registrar of Births and Deaths or the Municipal Corporation or any other prescribed
authority,whosoever has been empowered under the Registration of Birth and Deaths Act, 1969 to register the birth of a child born in
India
2.Driving Licenses (valid and within the jurisdiction of State of submission of application)
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 UMRETH
Date 19/02/2018