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2 Applicant Details

Applicant"s Given Name * (Given Name means First name followed by Middle name (If any))(Initials not allowed)

Surname *

Are you known by any other names (aliases)? If yes, provide details in Column 1 of Supplementary Form

Have you ever changed your name? If yes, provide details in Column 2 of Supplementary Form

Date of Birth (DD-MM-YYYY)

Place of Birth (Village or Town or City)

District (If born in India)

State/ UT (If born in India)

Country (If born abroad) If born before 15/08/1947 in a place now in Pakistan or Bangladesh, write "Undivided India"

Gender

Marital Status

Citizenship of India by

PAN (If available)

Voter ID (If available)

Employment Type

If employed in Government/ Statutory Body/ PSU, specify organization name

Is either of your parent (in case of minor)/ spouse, a government servant?

Educational Qualification

Are you eligible for Non-ECR category?

Visible Distinguishing Mark

Aadhaar Number

3 Family Details

Father Given Name (Given Name means First name followed by Middle name (If any)) (Initials not allowed)

Surname

Mother Given Name (Given Name means First name followed by Middle name (If any))(Initials not allowed)

Surname

Legal Guardian Given Name (If applicable) (Initials not allowed)

Surname

Spouse Given Name (Given Name means First name followed by Middle name (If any)) (Initials not allowed)

Surname

If applicant is minor, provide following details

Parent Passport Details (If passport has been applied for but not received, give File Number)

Father/ Legal Guardian File/ Passport Number

Father/ Legal Guardian Nationality, if not Indian

Mother/ Legal Guardian File/ Passport Number

Mother/ Legal Guardian Nationality, if not Indian

4 Present Residential Address Details (Where applicant presently resides)

Residing Since (MM-YYYY)

House No. and Street Name *

Village or Town or City *

District *

Police Station

State/ UT *

PIN *

Mobile Number *

Telephone Number

E-mail ID *

Is permanent address same as present address?

Residing Since (MM-YYYY)

House No. and Street Name

Village or Town or City

District

Police Station

State/ UT

Pincode

5 Emergency Contact Details

Name and Address

Mobile Number

Telephone Number

E-mail ID

6 Previous Passport/ Application Details

Details of latest held/ existing/ lost/ damaged Ordinary Passport/ Identity Certificate

Passport/ Identity Certificate Number

Date of Issue (DD-MM-YYYY)

Date of Expiry (DD-MM-YYYY)

Place of Issue If you have held/ hold any diplomatic/ official passport, provide details in Column 6 of Supplementary Form

Have you ever applied for passport, but not issued?

File Number

Month and Year of applying

Details

Name of passport office where applied

7 Other details

Have you ever been charged with criminal proceedings or any arrest warrant/ summon Yes No pending before a court in India?

Have you at any time during the period of 5 years immediately preceding the date of this application been convicted by a court in India for any criminal offence & sentenced to imprisonment for two years or more?

Have you ever been refused or denied passport?

Has your Passport ever been Impounded or Revoked?

Have you ever applied for/ been granted political asylum to/ by any foreign country?

Have you ever returned to India on Emergency Certificate (EC) or were ever deported or repatriated?

I have read and agree with the terms & conditions and policies of this application process.

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