11/29/2014

Application Form

Passport Application
Government of India, Ministry of External Affairs
Online Application Receipt
Applicant Details:
Application Reference No.
Service Type
Type of Application
Application Submitted Date
Date of Birth
Gender
Employment Type
Marital Status
Place of Birth
Given Name
Surname
Father's Name
Mother's Name
Present Address
Applicants References:
First Reference Details
Second Reference Details
Payment Details:#
Payment Status

14-0012478558
FRESH
Normal
29/11/2014
12/09/1990
MALE
NOT EMPLOYED
SINGLE
INDORE,INDORE,MADHYA
PRADESH
CHINMAY
BHATT
VIJAY KUMAR BHATT
MEENA BHATT
82-B PREM NAGAR, INDORE, INDORE, 452001, MADHYA PRADESH, INDIA
NIMISH SOMANI, 9179302737, 07312796025
VISHAL GUPTA, 9424515081

Not paid

Appointment Details:
PSK Location
Date and Time of Appointment
Appointment Id
Reporting Time
Thanks for showing your interest in 'Passport Seva SMS Services' enrolment. Please pay Rs 30/- (THIRTY ONLY) in cash as the
Enrolment Charges during your visit to Passport Seva Kendra.
Note:
Applicant should reach the Passport Seva Kendra by the reporting tim e m entioned above for pre-checking of docum ents
to avoid any hassles in issuance of token.
Applicant should bring all the originals and one set of photo copy, photo copies should be self attested by the applicant.
One accom panying person from the fam ily w ill be allow ed along w ith Senior Citizens, Physically Challenged, Illiterate and
Minor applicants only.
Applicant w ill not be issued token at Passport Seva Kendra, if they report after scheduled appointm ent tim e.
Minor applicants below 4 years of age need to carry a recent coloured passport size (4.5 x 3.5 cm ) photograph w ith a w hite
background w hile visiting Passport Seva Kendra. Other applicants need not carry any photograph as photograph w ill be
captured at the Passport Seva Kendra.
Carrying of corrosive substances or explosives, arm s or any sharp objects w hich m ay cause physical harm or violence are
prohibited inside the PSK. Electronic item such as cam era is prohibited inside the PSK.

# Details as per the Payment Date. Payment once made for availing passport services will not be refunded.

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Application Form

The following table lists Applicant Categories along with the Documents to be Submitted. The Document No. mentioned in
Documents to be Submitted column is the reference given to the document mentioned in List of Documents table.

Applicant Categories

Documents to be Submitted

Ordinary Case (Citizen of India by birth)

1, 2, 3 (if the applicant is eligible f or Non ECR)

Citizen of India by Descent (Born to Indian parent(s) outside India)

(i) 1, 2, 3 (if the applicant is eligible f or Non ECR)

(ii) 4 or 5 or 6

Citizen of India by Registration/ Naturalization (Granted citizenship by MHA)

1, 2, 3 (if the applicant is eligible f or Non ECR), 7

Applicants repatriated f rom abroad at Gov ernment cost

1, 2, 3 (if the applicant is eligible f or Non ECR), 5 (if av ailable), 8, 9

Applicants deported to India/ Emergency Certif icate cases

1, 2, 3 (if the applicant is eligible f or Non ECR), 5 (if av ailable), 8 (if any ), 9

Gov ernment/ Public Sector/ Statutory body employ ees

(i) 1, 2
(ii) 21 (if No Police Verif ication is required) or 20 (if Post Police Verif ication is
required)

Dependent f amily members of Gov ernment/ Public Sector/ Statutory body

employ ees (For J&K children in age group 10-15 y ears are cov ered. For rest of
India children in age group 18-21 are cov ered)

1, 2, 3 (if the applicant is eligible f or Non ECR), 21 (of dependent) and 24 if No

Police Verif ication is required

Retired gov ernment of f icials

1, 2, 10 (if Post Police Verif ication is required)

Applicants hav ing Diplomatic/ Of f icial Passport and apply ing f or ordinary
Passport while in serv ice

(i) 1, 2 , 11 (12 if surrender certif icate is not available)

(ii) 21 or 20 if applicant is Gov ernment/Public Sector/Statutory body employ ee
Note: In case the applicant submits "12", "2" is not required

Dependent f amily members of Diplomatic/ Of f icial Passport holders who are not
gov ernment serv ants (For J&K Children in age group 10-15 y ears are cov ered)

1, 2, 3 (if the applicant is eligible f or Non ECR), 26

Owner, partners and directors of Companies which are members of CII, FICCI & (i) 1, 2
ASSOCHAM.
(ii) 24 and 25 if Post PV is required
Minor change in name

1 (in new name), 2 (in old name), 3 (if the applicant is eligible f or Non ECR Documents in old name are allowed ), 23

Major change in name

1 (in new name), 2 (in old name), 3 (if the applicant is eligible f or Non ECR Documents in old name are allowed ), 13, 23

Change/ Addition in surname due to marriage

(i) 1, 2, 3 (if the applicant is eligible f or Non ECR)

(ii) 14 or 22

Change in name in case of Gov ernment/ Public Sector/ Statutory body

employ ees

1, 2, 15, 16, 23

Nagaland Residents

1, 2, 3 (if the applicant is eligible f or Non ECR)

Note: Additional PV required f rom Guwahati through MHA.

Naga origins residing outside Nagaland

1, 2, 3 (if the applicant is eligible f or Non ECR)

Note: Additional PV required f rom Guwahati through MHA.

Jammu and Kashmir Residents

1, 2, 3 (if the applicant is eligible f or Non ECR)

Jammu and Kashmir Residents stay ing outside J&K f or more than f iv e y ears

1, 2, 3 (if the applicant is eligible f or Non ECR)

Students stay ing away f rom their parent's current residence

1, 2, 3 (if the applicant is eligible f or Non ECR), 17, 18

Senior Citizens (For J&K: Men - 65+ y ears, Women - 60+ y ears; For rest of India 1, 2, 3 (if the applicant is eligible f or Non ECR), 19 (if Post Police Verif ication is
65+ y ears)
required)

Document
No.

List of Documents
Proof of Present Address. For Proof of Address attach one of the f ollowing documents:

1.

a. Water bill/ Telephone (landline or post paid mobile bill)/ Electricity bill (at least 2 bills are required - One bill should of be of last y ear and
the other bill of current y ear)
b. One y ear statement (with transactions)/ Passbook of running bank account (Public Sector Banks only )
c. Income Tax Assessment Order
d. Election Commission Photo ID card
e. Gas connection bill
f . Certif icate f rom Employ er of reputed and widely known companies on letter head (Only public limited companies can giv e address proof
on company letter head along with seal. Computerised print-outs shall not be entertained)
g. Spouse's passport copy (First and last page including f amily details), (prov ided the applicant's present address matches the address
mentioned in the spouse's passport)
h. Applicant's current and v alid ration card
NOTE 1: If any applicant submits only ration card as proof of address, it should be accompanied by one more proof of address out of
the giv en categories.
i. Parent's passport copy , in case of minors (First and last page)
j. Aadhaar Letter/ Card (If aadhaar card issuance date is less than a y ear f rom passport application processing date at PSK, it should be
accompanied by one more proof of address out of the giv en categories)
k. Registered Rent Agreement (f or a period of more than one y ear)

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Application Form
Proof of Date of Birth. For Proof of Date of Birth attach one of the f ollowing documents:

2.

a. Birth certif icate issued by a Municipal Authority or any of f ice authorized to issue Birth and Death Certif icate by the Registrar of Births &
Deaths
b. School leav ing certif icate / Secondary School leav ing certif icate/ Certif icate of Recognized Boards f rom the school last attended by the
applicant or any other recognized educational institution
c. Af f idav it sworn bef ore a Magistrate/Notary stating date/place of birth as per the specimen in Annexure "A" by illiterate or semi-illiterate
applicants (Less than 5th class).
For applicants born on or af ter 26.01.89, only Birth Certif icate issued by the Municipal Authority or any of f ice authorized to issue Birth and Death
Certif icate by the Registrar of Births & Deaths is acceptable. The Birth Certif icate should ordinarily contain the name of child, name of f ather and
mother, date of birth, place of birth, sex, registration number and date of registration. If the Birth Certif icate doesn't contain the name of child, a
declaration on plain paper signed by parents, is required to be submitted specif y ing the name of the child.

3.

Documentary proof f or any one of the Non-ECR (prev iously ECNR) categories, Ref er Column 2.15 under Section-B of passport instruction
booklet

4. Birth Registration Certif icate issued by Embassy / High Commission/ Consulate of India
5.

Old Passport in original with self -attested photocopy of its f irst two and last two pages, including ECR/Non-ECR page (prev iously ECNR) and the
page of observ ation (if any ), made by Passport Issuing Authority and v alidity extension page, if any , in respect of short v alidity passport

6.

Passport of parents in original with self -attested photocopy of its f irst two and last two pages, including ECR/Non-ECR page (prev iously ECNR)
and the page of observ ation (if any ), made by Passport Issuing Authority and v alidity extension page, if any , in respect of short v alidity passport

7. Citizenship Certif icate issued by Ministry of Home Af f airs

8. Proof of ref und of repatriation /deportation cost (if any ) to Ministry of External Af f airs
9. Original Emergency Certif icate/Seizure Memo issued by Airport Immigration Authorities on applicant's arriv al in India
10. Pension Pay ment Order
11. Proof of surrender or cancellation of Diplomatic/of f icial Passport
12. Cancelled Passport (if surrender certif icate is not av ailable), with a letter explaining why surrender certif icate is not av ailable
13.

Paper clipping of two leading daily newspapers in original (one daily newspaper should be of the area of Applicant's Permanent Address and the
other at Current Address or nearby area)

14. An attested copy of marriage certif icate issued by Registrar of Marriage

15. Gazette Notif ication changing name in applicant's department
16. Fresh ID Certif icate in changed name
17. Student Identity Card issued by Gov ernment Recognized Educational Institutions, in respect of f ull time courses
18. Bonaf ide Letter f rom authorized signatory of college (On of f icial letter head of UGC recognized College)
19. Copy of child's (Age>18) Passport , who is stay ing abroad (with page hav ing parent's name)
20. No Objection Certif icate (NOC) (as per Annexure 'M')
21. "Identity Certif icate" in original as per Annexure "B"
22.

A joint af f idav it f rom husband and wif e along with a joint photograph, (Specimen at Annexure "D") When joint af f idav it is not possible the af f idav it
should indicate the reason f or it. If apply ing f or passport f or the f irst time, this af f idav it is required only if there is a change in the f irst name.

23. Deed poll/sworn af f idav it as per Annexure "E"

24. Standard Af f idav it as per Annexure "I"
25. Verif ication Certif icate as per Annexure "J"
26. Photocopy of Diplomatic/ Of f icial Passport

Note: The list of documents provided in the table above is indicative. The decision of APO/RPO shall be considered final.

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