Pnei14132912 ja1203
- 1. PNEI14132912 Government of India Ministry of External Affairs Paste your Passport Application Form (No.1) unsigned recent (For New / Re-issue/ Replacement of Lost/Damaged Passport) colour (Please tick the required category) photograph. Size: 3.5 X 3.5 cm Signature or Thumb Impression Please read the Passport Information Booklet carefully before filling the form, in CAPITAL LETTERS in blue/ black ball point pen only: (CAUTION: Please furnish correct information. Furnishing of incorrect information would attract penal provisions as prescribed under the Passports Act, 1967). Please produce your original documents at the time of submission of the form. For official use only File Number ……………………………….. Police Verification required (Yes/No) ECR / ECNR ………………………………… Signature of Checking Official Fee Amount Rs. Cash /D.D Bank Code D.D No. Date of Issue of D.D 1000 CASH 10 A.M. 1. Name of applicant as it should appear in the Passport (Initials not allowed) Surname Given Name AMANPREET SINGH 06-JUN-2012 (with documentary proof) 2. In case of change of name/surname (after marriage or otherwise with documentary proof), please indicate the previous name/surname in full 3. Sex MALE 4. Date of Birth: 03-DEC-1989 (with documentary proof) PNEI14132912 In words.________________________________________________ 5. Place of Birth: Village / Town, District, State, Country (with Documentary Proof) PUNE PUNE 6. Father/Legal Guardian's Full Name (including surname, if any): (Initials not allowed) GURNAM SINGH 7. Mother’s Full Name (including surname, if any): (Initials not allowed) JASWINDER KOUR 8. If married, Full Name of wife/husband (including surname, if any). (Initials not allowed). 8 (i) If divorced/widow/widower, Please indicate the category with documentary proof. AMANPREET SINGH
- 2. 9. Current Residential Address (where staying presently), Residing since 13-AUG-2011 (In case of students, please see Section III of Passport Information Booklet) C/O V.S.TRIPATHI,SR.NO-148/1/1/10, COLONY NO-8,GANESH NAGAR, BOPKHEL,CME PUNE-411031 Telephone No /Email Address. Mobile No. 8446406031 amanpreetsaini007@gmail.com 8983561045 9 (a) If you have been resident at your current address for less than one year, please furnish other addresses of your residence during the last one year. From……………..To…………………. 01-OCT-2010 01-AUG-2011 From…………………To…………….. QTR NO-104/3,MILITARY QTRS ASHOK NAGAR,DEHUROAD PUNE-412101 10. Permanent Address with PIN code (if the permanent address is same as the present address write “Same” only) SUB GURNAM SINGH S/O PRITAM SINGH VILL- KAINTHAL KHURD P.O- KIRMUCH PNEI14132912 DISTT-KURUKSHETRA HARYANA 136118 11. Details of latest held/existing Ordinary / Diplomatic / Official passport(s): (i) Passport Office File No.……………………………/Passport(s) No......……………………........….. (ii) Date and Place of Issue: ………………………............................../Date of Expiry …………...…… (iii) In case passport was applied for and not issued, please give File No. & Date ……………………… (iv) Has your passport(s) ever been lost / damaged (if so attach FIR and give details)………………….. ……………………………………………………………………………………………………….. 11. (a) If you have returned to India on Emergency Certificate (EC) or were ever deported or repatriated, please furnish details: EC No., date and place of issue & attach seizure memo in original ………………………………... Place & Country from where deported / repatriated and reason thereof:…………………………… ..……………………………….…………………. ………………………………………………… ………………………………………………………………………………………………………. 12. Other Details: PURSUING BE a) Educational Qualifications………………………………………………………………………….. BLACK MOLE ON FORE HEAD b) Visible Distinguishing Mark, if any…………………………………………………………………. 175 c) Height …………………cms. STUDENT d) Profession ...................................................... 13. Are you working in Central Government/ State Govt/ PSU/ Statutory Bodies (Y)es/ (N)o If ‘Yes’ attach Identity Certificate (As per Annexure “B” of Passport Information booklet). 14. Are you a citizen of India by: (B)irth/(D)escent/(R)egistration/(N)aturalisation; ………………………. If you have ever possessed any other citizenship, please indicate previous citizenship ………………… 15. “Emigration Check Not Required” status? Yes/No ………………… (Please note that all 10 and above qualified applicants are eligible for ECNR status.) If yes, mention the eligible category (see Section III of Passport Information Booklet) and enclose copy of relevant certificate/document__________________________________________________________
- 3. 16. In case of minors (applicant below the age of 18), if EITHER of the parents hold a Valid Indian Passport or has applied for it give the following details. Please see and fill up attached Annexure-H. Passport/ File No. Date & Place of Issue/ Application Mother _______________ _________________________________ Father _______________ _________________________________ PNEI14132912 17. (a) Have you at any time during the period of Five 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? If so, give name of the court, case number and relevant sections of Law. (Attach copy of judgement) ………………………………………………………………………………………………………….. (b) Are any criminal proceedings pending against you before a court in India? If so, give name of court, case number and relevant sections of Law. ………………………………………………………………………………………………………….. (c) If answer at (b) is (Y)es, please furnish No Objection Certificate from competent court for grant of Passport. ………………………………………………………………………………………………………… ……………………………………………………………………………………………………….... (d) Have you been ever refused/denied passport? If yes, give details: …………………………………………………………………………………………………….….. …………………………………………………………………………………………………….….. (e) Has your passport ever been impounded / revoked? If yes, give details: ……………………………………………………………………………………………………….. ……………………………………………………………………………………………………….. (f) Have you ever applied/granted political asylum by any foreign country? If yes, give details. ……………………………………………………………………………………………………….. ……………………………………………………………………………………………………….. 18. Particulars of person to be intimated in the event of death or accident: Name ……………………………………………………………………………………….. Address ……………………………………………………………………………………….. ……………………………………………………………………………………….. Mobile / Tel. No. / email ID ………………………………………………………………………… 19. Self Declaration: I owe allegiance to the sovereignty, unity & integrity of India, and have not voluntarily acquired citizenship or travel documents of any other country. I have not lost, surrendered or been deprived of citizenship of India. The information given by me in this form and enclosures is true and I am solely responsible for its accuracy. I am aware that it is an offence under the Passports Act, 1967 to furnish any AMANPREET SINGH false information or to suppress any material information with a view to obtaining a passport or any other travel document. I further declare that I have no other passport/ travel document. (Signature/Thumb Impression of Applicant) Date …………. (Left Hand Thumb Impression if male and Right Hand Thumb Impression if female) Place …………
- 4. 20. Enclosures: 1 Proof of date of birth .………………………… 2 Proof of Residence ………………………… 3 Educational Qualifications …………………… 4 ……..……..……………………………….. 5 ………………………………………………… 6 ……………………………………………. PNEI14132912 (For Official Use Only) Checked by Name Signature/date Granted by Name Signature/date Scanned by Name Signature/date Dispatched by Name Signature/date AMANPREET SINGH
- 5. Paste your cross signed PERSONAL PARTICULARS FORM recent colour (In Duplicate) photograph. Size: 3.5 X 3.5 cm PNEI14132912 1. Full name (Initials not allowed) AMANPREET SINGH ……………………………………………………………………………………………………………… MALE 2. Sex: Male / Female / Others ………………………………. (a) Has the applicant ever changed name? (b) If yes, previous name: …………………………………………………………………………………. 03-DEC-1989 PUNE 4. Date of Birth:………………………………… 5. Place of Birth ………………………………………… STUDENT 6. Profession …………………………………………………………………………………………………. GURNAM SINGH 7. a) Father …………………………………………………………………………………………………… (Surname) (Name) b) Mother…………………………………………………………………………………………………. JASWINDER KOUR (Surname) (Name) c) Husband / wife ………………………………………………………………………………………. . (Surname) (Name) 8 a) Permanent Address & Tel. No. 8(b) Present Residential Address & Tel. No, along with along with Police Station Police Station and residing since ………………………………………………. SUB GURNAM SINGH S/O PRITAM SINGH …………………………………………………… C/O V.S.TRIPATHI,SR.NO-148/1/1/10, ………………………………………………. VILL- KAINTHAL KHURD P.O- KIRMUCH …………………………………………………… COLONY NO-8,GANESH NAGAR, ………………………………………………. DISTT-KURUKSHETRA HARYANA 136118 BOPKHEL,CME PUNE-411031 …………………………………………………… ………………………………………………. 8446406031 …………………………………………………… 9. If you have not been resident at the address given at COLUMN 8(b) continuously for the last one year, please furnish other address(es) with duration(s) resided (Please furnish an additional set of P P Forms for each address with Police station. From……………..To…………………. 01-OCT-2010 01-AUG-2011 From…………………To………………. ________________________________ QTR NO-104/3,MILITARY QTRS _________________________________ ________________________________ ASHOK NAGAR,DEHUROAD _________________________________ ________________________________ PUNE-412101 _________________________________ ________________________________ _________________________________ 10. References: Names and Addresses of two responsible persons in the applicant’s locality who can vouch for the applicant. (1) Name, Address & Tel. No. (2) Name, Address & Tel. No. ………………………………………………. …………………………………………………… ………………………………………………. …………………………………………………… ………………………………………………. …………………………………………………… PNEI14132912 11. Citizenship of India by: Birth Descent Registration Naturalization 12. Furnish details of previous passport / travel document, if any: (i) Passport/Travel document No: ……………………... (ii) Date & Place of issue ……………………. For Police Use Only Recommended Passport: YES/NO Signature or Thumb Impression of the applicant (Left Hand T.I. if male and Right Hand T.I. if female)
- 6. Paste your cross signed PERSONAL PARTICULARS FORM recent colour (In Duplicate) photograph. Size: 3.5 X 3.5 cm PNEI14132912 1. Full name (Initials not allowed) AMANPREET SINGH ……………………………………………………………………………………………………………… MALE 2. Sex: Male / Female / Others ………………………………. (a) Has the applicant ever changed name? (c) If yes, previous name: ……………………………………………………………………………….. 03-DEC-1989 PUNE 4. Date of Birth:………………………………… 5. Place of Birth ………………………………………… STUDENT 6. Profession ………………………………………………………………………………………………….. GURNAM SINGH 7. a) Father ………………………………………………………………………………………………….. (Surname) (Name) b) Mother………………………………………………………………………………………………….. JASWINDER KOUR (Surname) (Name) c) Husband / wife ………………………………………………………………………………………. . (Surname) (Name) 8 a) Permanent Address & Tel. No. 8(b) Present Residential Address & Tel. No, along with along with Police Station Police Station and residing since SUB GURNAM SINGH S/O PRITAM SINGH ………………………………………………. …………………………………………………… C/O V.S.TRIPATHI,SR.NO-148/1/1/10, VILL- KAINTHAL KHURD P.O- KIRMUCH COLONY NO-8,GANESH NAGAR, ………………………………………………. …………………………………………………… DISTT-KURUKSHETRA HARYANA 136118 ………………………………………………. BOPKHEL,CME PUNE-411031 …………………………………………………… ………………………………………………. 8446406031 …………………………………………………… 9. If you have not been resident at the address given at COLUMN 8(b) continuously for the last one year, please furnish other address(es) with duration(s) resided (Please furnish an additional set of P P Forms for each address with Police station. From……………..To…………………. 01-OCT-2010 01-AUG-2011 From…………………To………………. ________________________________ QTR NO-104/3,MILITARY QTRS _________________________________ ________________________________ ASHOK NAGAR,DEHUROAD _________________________________ ________________________________ PUNE-412101 _________________________________ ________________________________ _________________________________ 10. References: Names and Addresses of two responsible persons in the applicant’s locality who can vouch for the applicant. (1) Name, Address & Tel. No. (2) Name, Address & Tel. No. ………………………………………………. …………………………………………………… ………………………………………………. …………………………………………………… ………………………………………………. …………………………………………………… PNEI14132912 11. Citizenship of India by: Birth Descent Registration Naturalization 12. Furnish details of previous passport / travel document, if any: (i) Passport/Travel document No: ……………………... (ii) Date & Place of issue ……………………. For Police Use Only Recommended Passport: YES/NO Signature or Thumb Impression of the applicant (Left Hand T.I. if male and Right Hand T.I. if female)