16/03/2024, 13:51 View/Print Submitted Form
File Number (For Office Use Only)
GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS
PASSPORT APPLICATION FORM
Please read the Passport Instruction Booklet carefully before filling the form. Fill this form in CAPITAL LETTERS using
blue/black ink ball point pen only. Furnishing of incorrect information/ suppression of information would lead to rejection of the
application and would attract penal provisions as prescribed under the Passports Act, 1967. Please produce your original
documents at the time of submission of the form.
Service Required
Application Reference Number 24-0004877684
Applying For FRESH
Type of Application TATKAAL
Type of Passport Booklet JUMBO
Applicant Details
Applicant's Name VAIBHAV JAKHAR
Date of Birth (DD/MM/YYYY) 01/07/2000
Validity Required NA
Place of Birth (Village/Town/City) DELHI
District DWARKA
State/UT DELHI
Region/Country INDIA
Signature/Left Hand Thumb Impression
Gender MALE of Illiterate Applicant and Minors who
Marital Status SINGLE cannot sign.
Citizenship of India by BIRTH
PAN BTGPJ6408M
Voter Id YDI5146477
Employment Type STUDENT
Is either of your parent (in case of
Y
minor)/spouse, a government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark MOLE ON RIGHT HAND WRIST
Aadhaar Number 749068625102
Family Details
Father's Name JAGDEV JAKHAR
Mother's Name NEELAM JAKHAR
Present Residential Address Details
RZ-152 DHARAMPURA 1 NAJAFGARH, NEW DELHI,
Address
DWARKA, DELHI
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16/03/2024, 13:51 View/Print Submitted Form
PIN 110043
Police Station NAJAFGARH
Mobile/Tel No. 9560213633
E-mail VAIBHAVJAKHAR0000@[Link]
Permanent Residential Address
RZ-152 DHARAMPURA 1 NAJAFGARH, NEW DELHI,
Address
DWARKA, DELHI
PIN 110043
Police Station NAJAFGARH
Mobile/Tel No. 9560213633
Emergency Contact Details
Name and Address NEELAM RZ-152 DHARAMPURA 1 NAJAFGARH NEW DELHI
Mobile/Tel No. 8053980225
E-mail NEELAMJAKHAR11@[Link]
Other Details
Fee Details (Not to be filled by applicants submitting the application at Passport Seva Kendra/Passport Office)
Fee amount in (Rs)
If paid by Demand Draft(DD), provide the following details
DD Issue Date (dd/mm/yyyy)
DD Expiry Date (dd/mm/yyyy)
Bank Name
Branch
Enclosures
[Link] License issued by the Transport department of concerned state Government
[Link] Licenses (valid and within the jurisdiction of state of submission of application)
Self 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. I have not contravened any of the conditions
relating to the possession and use of an Indian passport.
I affirm that the information and particulars given by me in this form are true and correct. I further state that I am not suppressing
any material information in this regard. I further affirm that the enclosures and documentary proof submitted in support of my
application for an Indian passport are authentic and solely pertain to me and I am fully responsible for the accuracy of the same. 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.
I have read and understood the contents of the above and by submitting this form certify that all the information submitted by me in
the form is bonafide.
Place NEW DELHI Signature/Left Hand Thumb Impression of
Applicant (If applicant is minor, either parent
Date 16/03/2024 to sign)
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