1/18/14 Application Form

Passport Application
ATM facility available in PSK
Government of India, Ministry of External Affairs
for all Bank Cards
Online Application Receipt
Applicant Details :
Application Reference No 14-0000553458
Service Type FRESH Batch 2
Type of Application Normal
Application Submitted Date16/01/2014
Sequence No. 24
Date of Birth 28/02/1986 Reporting Time 09:30 AM
Gender MALE
Employment Type PRIVATE
Marital Status SINGLE
Place of Birth PUNE,PUNE CITY,MAHARASHTRA
Given Name RAHUL VIJAY
Surname AGARWAL
Father's Name VIJAY MADANLAL AGARWAL
Mother's Name URMILA VIJAY AGARWAL
Present Address 2130 NEW MODI KHANA NR POOLGET CHAUKI, CAMP PUNE, PUNE CITY - 411001, MAHARASHTRA,
INDIA
Applicants References :
First Reference Details PRADEEP AGARWAL 2130 NEW MODI KHANA CAMP PUNE 411001, 9850231499
Second Reference Details GIRISH SURANA GAGAN VIHAR SOC MARKETYARD PUNE 411037, 9881123203
Payment Details:#
Total Fee (Rs.) 1500.00
Paid Fee (Rs.) 1500.00
Date and Time 18/01/2014 01:12 PM
Transaction Id CP04117860
Appointment Details :
Pune,
ZERO ONE, S.NO.79/1,GHORPADI -
PSK Location
MUNDHWA ROAD,PINGLE WASTI,
OPP. GANGA ORCHID,PUNE-411036
Date & Time of
28/02/2014 & 09:45 AM
Appointment
Appointment Id 100004683475914
Reporting Time 09:30 AM

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. In case
of m inor either of the parents has to sign on all photo copies.
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.
Balance fee (if applicable) after editing the subm itted form w ill be payable in cash at the Passport Seva Kendra.
# Details as per the Payment Date. Payment once made for availing passport services will not be refunded.

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