Please enable JavaScript in your browser to complete this form.Service RequiredLayoutApplying For *-- Choose Type --Fresh PassportRe-issue of PassportType of Application *NormalTatkaalType of Passport Booklet *36 Pages60 PagesApplicant DetailsLayoutApplicant's Given Name *(Given Name means First Name followed by middle Name (if any))Surname *Gender *-- Choose --MaleFemaleTransgenderAre you known by any other names(aliases)? *YesNoLayoutHave you ever changed your name ? *YesNoDate of Birth *Place Of BirthLayoutIs your Place of Birth out of India? *YesNoVillage or Town or City *PAN (If available) *State *Marital Status *-- Choose --SingleMarriedDivorcedWidow / widowerSeparatedVoter ID (If available) *District *Citizenship of India by *-- Choose --BirthDescentRegistration / NaturalizationAadhaar Number *LayoutEmployment Type *-- Choose --GovernmentHomemakerNot employedOwners, Partners & Directors of companies which are members of CII, FICCI & ASSOCHAMPrivatePSURetired Government ServantRetired - Private ServiceSelf EmployedStatutory BodyStudentothersOrganistion Name *Is either of your parent (in case of minor)/ spouse, a government servant? *YesNoLayout (copy)Educational Qualification *-- Choose --5th pass or lessBetween 6th and 9th standard10th pass and aboveGraduate and aboveAre you eligible for Non-ECR category? *YesNoI, the holder of above mentioned Aadhaar Number , hereby give my consent to Passport Seva to obtain my Aadhaar Number, Name and Fingerprint/Iris for authentication with UIDAI. I have no objection using my identity and biometric information for validation with Aadhaar (CIDR) database only for the purpose of authentication.I agree *YesNoFamily Details (Father/Mother/Legal Guardian details; at least one is mandatory.)LayoutFather's Given Name(Given Name means First Name followed by Middle Name (If any))SurnameLayoutMother's Given Name(Given Name means First Name followed by Middle Name (If any))SurnameLayoutSpouse's Given Name (if applicable)(Given Name means First Name followed by Middle Name (If any))SurnamePresent Residential Address Details (where applicant presently resides)Present Residential Address Details *YesNoResiding Since *House No. and Street Name *Village or Town or City *State/ Province *District/ Country *Police Station *ZIP Code *Mobile Number *Telephone Number *Email ID *Is permanent address same as present address?YesNoEmergency Contact DetailsLayoutName and Address *Telephone Number *Mobile Number *Email ID *Previous Passport / Application DetailsDetails of Previous/Current Diplomatic/Official Passport *YesNoHave you ever applied for passport, but not issued? *YesNoEmergency Contact Details1) Have you ever been charged with criminal proceedings or any arrest warrant/ summon pending before a court of India? *YesNo2) 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 and sentenced to imprisonment for two years or more? *YesNo3) Have you ever been refused or denied passport? *YesNo4) Has your Passport ever been impounded or Revoked? *YesNo5) Have you ever applied for/ been granted political asylum to by any foreign country? *YesNo6) Have you ever returned to India on Emergency Certificate (EC) or were ever deported or repatriated? *YesNoSelf Declaration I owe allegiance to the sovereignty , unity & 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 Passport 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.I agree *I agreeLayoutPlace *Date *NOTE: Applicants are required to submit the proof of address of the present address only, irrespective of the date from which he/she has been residing at the given address. However, he/she is required to mention all the places of stay during previous one year (from the date of application filling) in the Passport application form.Submit
