APPLICATION FORM FOR INDIAN PASSPORT ARN: 25-2001074126 3/6/25, 11:21 PM

365 BLOOR ST E #700, TORONTO ONTARIO, ON M4W 3L4, CANADA

00-1-416-9600751 http://www.cgitoronto.gov.in/
PASSPORT PREVIEW

भारत गणराज्य REPUBLIC OF INDIA

टाइप/Type राष्ट्र कोड/CountryCode पासपोटर् नं./PassportNo.
Paste your unsigned recent color photograph of Size 2"X2" and Signature/Left Hand Thumb Impression in the box provided

P IND
उपनाम/Surname
Paste your unsigned
SAREEN
recent color photograph िदया गया नाम/Given Name(s)

Size 2"X2" and NIKHIL

राष्ट्रीयता/Nationality िलं ग/Sex जन्मितिथ/Date of Birth
Signature/Left Hand
INDIAN M 30/11/1997
Thumb Impression in
जन्म स्थान/Place of Birth
the box provided below

CHANDIGARH, CHANDIGARH

Generated on: Thursday, March 6, 2025 11:19:20 PM

जारी करने का स्थान/Place of Issue

जारी करने की ितिथ/Date of Issue समािप्त की ितिथ/Date of Expiry

िपता/कानूनी अिभभावक का नाम/Name of Father/Legal Guardian

DEEPAK SAREEN

माता का नाम/Name of Mother

SUCHITA SAREEN

पित या पत्नी का नाम/Name of Spouse

पता/Address

HOUSE NO: 3048, SECTOR 27 D

CHANDIGARH, CHANDIGARH

PIN:160019, CHANDIGARH, INDIA

पुराने पासपोटर् का नं. और इसके जारी होने की ितिथ एवं स्थान/Old Passport No with Date and Place of Issue

Z3397671 22/09/2015 CHANDIGARH

फ़ाइल नं./File No.

Service Required
Application Reference Number (ARN) 25-2001074126
Applying For REISSUE
If Re-issue, specify reason(s) VALIDITY EXPIRED WITHIN 3 YEARS/DUE TO EXPIRE.
Type of Application TATKAAL
Type of Passport Booklet 60 Pages

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 APPLICATION FORM FOR INDIAN PASSPORT ARN: 25-2001074126 3/6/25, 11:21 PM

Applicant Details
Applicant's Name NIKHIL SAREEN
Applicant's Alias Name N
Applicant's Change In Name N
Date of Birth (DD/MM/YYYY) 30/11/1997
Validity Required NA
Place of Birth (Village/Town/City) CHANDIGARH
District CHANDIGARH
State/UT CHANDIGARH
Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN NNTPS9907P
Voter Id NO
Employment Type NOT EMPLOYED
Is either of your parent (in case of minor)/spouse, a government servant? N
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark CUT NEAR LEFT LOWER LIP
Aadhaar Number 914190337119
Family Details(as in passport)
Father's Name DEEPAK SAREEN
Mother's Name SUCHITA SAREEN
Legal Guardian's Name NA NA
Passport Printable Address Details
HOUSE NO: 3048, SECTOR 27 D CHANDIGARH,
To be printed on passport
CHANDIGARH PIN:160019, CHANDIGARH, INDIA
Mobile/Telephone Number 9876755773
E-mail [email protected]
Other Address Details
Address 55 MERCER STREET, TORONTO M5V 0W4 Canada
Mobile/Telephone Number 4374380109 / 4379948987
Emergency Contact Details
DISHA SAREEN, 55 MERCER STREET, TORONTO, M5V 0W4,
Name and Address
CANADA
Mobile/Telephone Number 14379948987 / 14379948987
E-mail [email protected]
Previous Passport
Passport Number Z3397671
Date of Issue 22/09/2015
Date of Expiry 21/09/2025
Place of Issue CHANDIGARH
File Number EGYC00024315
Have you ever applied for passport, but not issued? N
Details of Previous/Current Diplomatic/Official Passport N
Other Details
1) Provide the following details if there are any criminal proceedings pending against the applicant.
1.1) Are any proceedings in respect of an offence alleged to have been committed by you pending before a criminal court in India? N
1.2) Has any warrant or summons for your appearance been issued and pending before a court under any law for the time being in force? N
1.3) Has a warrant for your arrest been issued by a court under any law for the time being in force? N
1.4) Has an order prohibiting your departure from India been made by any court? N
2) Provide the following details if the applicant has been convicted by a court in India.

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 APPLICATION FORM FOR INDIAN PASSPORT ARN: 25-2001074126 3/6/25, 11:21 PM

2.1) 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 offence N
involving moral turpitude and sentenced in respect thereof to imprisonment for not less than two years?
3) Provide the following details if the applicant has been refused/denied passport.
3.1) Have you ever been refused/denied passport? N
3.2) Has your passport ever been impounded? N
3.3) Has your passport ever been revoked? N
4) Provide the following details if applicant has applied for or been granted foreign citizenship.
4.1) Have you ever applied for or been granted citizenship by any other country? N
4.2) Have you ever held the passport of any other country at any time? N
4.3) Have you ever surrendered your Indian passport? N
4.4) Have you ever applied for renunciation of Indian citizenship? N
5) Provide the following details if applicant has returned to India on Emergency Certificate.
5.1) Have you ever returned to India on Emergency Certificate (EC)? N
5.2) Have you ever been deported from any country? N
5.3) Have you ever been repatriated from any country back to India? N
Self Declaration
I declare:

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.
I understand:

That Ministry of External Affairs (MEA) (or its implementation partner agencies/stakeholders/third parties) may undertake required checks to confirm the accuracy and
authenticity of evidence I have provided and documents I have submitted with this application.
That the information I provide, including biometric data (if any), will be treated in confidence, but it may be disclosed to other government departments, agencies, local
authorities, foreign governments, and other implementation partner agencies/stakeholders/third parties to enable MEA or those bodies to perform their duties.
That providing biometric information, if collected as part of an application, is confirmation of my consent to getting the biometric information checked to verify identity.
That the Passport and related services applications may be handled by the Indian Embassies/Consulates/ Passport Office/other offices including outside of the country in which
I have applied and that this may involve the transfer of my application and supporting documents to and from the respective offices.
That my details may, in certain circumstances, be passed to Police, Intelligence and other Fraud Detection & Prevention agencies. I also understand that such agencies may
provide related information about me to MEA.

Place TORONTO,
CANADA Signature/Left Hand Thumb Impression of Applicant
(If applicant is minor, either parent to sign)
Date 06/03/2025

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