PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 24-0018250686
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name MADIYA ABDUL KARIM KHATRI
Date of Birth (DD/MM/YYYY) 08/04/2002
Validity Required NA
Place of Birth (Village/Town/City) MUMBAI
District THANE RURAL MB-VV
State/UT MAHARASHTRA
Region/Country INDIA
Gender FEMALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN JTQPK4856Q
Employment Type PRIVATE
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? Y
Visible Distinguishing Mark NO
Aadhaar Number 564235760529
Family Details
Father's Name ABDUL KARIM I KHATRI
Mother's Name SHEHNAZ ABDUL KARIM KHATRI
Present Residential Address Details
403,HUSSAIN NIYAZ CHS LTD ALIBAGH ROAD,UTTAN, MUMBAI, THANE RURAL
Address
MB-VV, MAHARASHTRA
PIN 401106
Police Station UTTAN
Mobile/Tel No. 8879948451
E-mail [email protected]
Permanent Residential Address
403,HUSSAIN NIYAZ CHS LTD ALIBAGH ROAD,UTTAN, MUMBAI, THANE RURAL
Address
MB-VV, MAHARASHTRA
PIN 401106
Police Station UTTAN
Mobile/Tel No. 8879948451
Emergency Contact Details
Name and Address SHEHNAZ ABDUL KARIM KHATRI
Mobile/Tel No. 9833759612
E-mail [email protected]
Other Details
Enclosures
1.Birth certificate issued by the Registrar of Births and Deaths or the Municipal Corporation or any other prescribed authority whosoever
has been empowered under the Registration of Birth and Deaths Act, 1969 to register the birth of a child born in India
2.Aadhaar Card (Address Proof)
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 UTTAN NAKA
Date 29/10/2024
