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Government Of India, Ministry of External Affairs

Please Read the Passport Information Carefully before felling the form Furnishing of incorrect information/Suppression of information would lead to rejection of Application. Please fill all information correct. You have to producece your orginal documents at the time of submission. Application appearance is mendatory. All fields are marked with(*)are mendatory to fill.

Service Required      :

if-re-essue,Specify reason(s)*:    


Type of Application :                                Type of passport Booklet* :               
Applicant Given Name  Surname
Are you know by any other names(aliasis)?*    if yes,Provide previus Name
Date of Birth(dd/mm/yyyy/) Place of Birth
Sate Distric(if in india)
Country Are you eligible for Non-ECR Category
Gender Marital Status
Citizenship of india by* Visible Mark (if any
PAN No.(Available): Voter ID No.(If Available)
Father's Full Name Surname
Mother's Full Name Surname
Employment Type Education Qualification*
Resident Name Month    Year

Complete Home Address

State * Distric
Pin Code   Police Station
Mobile No *   Telephone No *  
Is Permanent address same as present address ? * Yes No (If yes)Provide Full address (If You are leaving on rent)
Emergency Contact Details
Name and Address

Contact No

  Email-ID(If any) *
Refrences In your Nearest Neighbors
Name Name
Full Name Full Name
Contact No   Contact No  
Other Details
1)Have you ever been charged with criminal proceedling or any arrest warrant/summan pending before a cout of india?*
2) Have you at any time during the period of 5 years emmediately proceding the date of this application been convicted by a court in india for any criminal offence and sentenced to impresonment for two years or more?*
3) Have you ever been refused or denied passport ?*
4) Has your passport ever been impoundid or Revoked
5) Have you ever applied for/been granted poltical asylum to/ by any foreign country?*
6) Have you ever returned to india on Emergency certificate (EC)or were ever deported or repattriated ?
Self Declaration
I own allegiance for the soverelgenty,integrity of india, have not voluntarily acquired citizents help or travel documents of any other country. I have not lost, surrendered or been deprived of the citizenship of india and i affirm that the information the given by me in this form and the enclosures is true and i solely resposible for its eccurecy, and i am able to be penalized or procecuted if found otherwise. i am aware that under the passport Act, 1967 it is a criminal offence furnice any false information or to suppress to any material information with a view to obtaining passport or travel document.
PlaceYour Name *


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