File Number (For Office Use Only)

GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS PASSPORT APPLICATION FORM (DIPLOMATIC/ OFFICIAL)
Please 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. It is mandatory to fill each item. Incomplete form will be rejected summarily. (i) Please enclose original safe custody Certificate of Valid Ordinary Passport (if held) from your office. (ii) If Diplomatic/ Official passport previously held by the applicant was kept in the safe custody of the Ministry of External Affairs, the original certificate should be enclosed. (iii) Official/ Diplomatic/ Ordinary Passport which is around 10 years old or more (from the date of issue) must be submitted with the application for cancellation. (iv) Official retiring in less than six months from the date of application, is required to give an undertaking from his/ her office that he/ she will surrender dip./ off. passport to his/ her office immediately after return. 1. Applying for 2. Type of Passport 3. Applicant Details 3.1 Applicant's Given Name (Given Name means First name followed by Middle name (If any))(Initials not allowed) Fresh Passport Diplomatic Re-issue of Passport Official

Please paste your unsigned recent colour photograph with white background of size 4.5cm X 3.5cm.

Signature/ Left Hand Thumb Impression of Illiterate Applicant and Minors who cannot sign.

Surname

3.2 Date of Birth (DD-MM-YYYY)

3.3 Place of Birth (Village or Town or City)

District (If born in India)

State/ UT (If born in India) Page 1 of 6

Country (If born abroad) If born before 15/08/1947 in a place now in Pakistan or Bangladesh, write "Undivided India"

3.4 Gender 3.5 Employment Type 3.6 Name of the Organization

Male Government

Female Statutory Body PSU Autonomous Bodies

3.7 Designation

3.8 Pay Band 3.9 Grade Pay 4. Family Details

From

To

4.1 Father's Given Name (Given Name means First name followed by Middle name (If any)) (Initials not allowed)

Surname

4.2 Mother's Given Name (Given Name means First name followed by Middle name (If any)) (Initials not allowed)

Surname

4.3 Spouse's Given Name (Given Name means First name followed by Middle name (If any)) (Initials not allowed)

Surname

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4.4 Legal Guardian's Given Name (If applicable) (Initials not allowed)

Surname

5. Present Residential Address Details 5.1 House No. and Street Name

Village or Town or City

District

Police Station

State/ UT

Country

PIN

Mobile Number

Telephone Number

E-mail ID

5.2 Is permanent address same as present address? 6. Permanent Residential Address Details House No. and Street Name

Yes

No If no, provide details in Column 6 below

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Village or Town or City

District

Police Station

State/ UT

Country

PIN

Mobile Number

Telephone Number

E-mail ID

7. Previous Passport/ Application Details (ordinary/ official/ diplomatic passport) 7.1 Details of latest held/ existing/ lost/ damaged ordinary passport Passport Number Date of Issue (DD-MM-YYYY) Place of Issue Date of Expiry (DD-MM-YYYY) -

7.2 Details of latest held/ existing/ lost/ damaged diplomatic/ official passport Passport Number Date of Issue (DD-MM-YYYY) Place of Issue Date of Expiry (DD-MM-YYYY) -

7.3 Have you ever applied for passport, but not issued?

Yes

No If yes, provide the following details Page 4 of 6

File Number

Month and Year of applying -

Name of passport office where applied

8. Details of countries to be visited/ transited 8.1 Country to be visited on official duty

Country to be transited

Purpose and Duration of visit

8.2 Country to be visited on official duty

Country to be transited

Purpose and Duration of visit

8.3 Country to be visited on official duty

Country to be transited

Purpose and Duration of visit

8.4 Country to be visited on official duty

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Country to be transited

Purpose and Duration of visit

Place

Date (DD-MM-YYYY) -

Signature/ Left Hand Thumb Impression of Applicant (If applicant is minor, either parent to sign)

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