Government of India

Ministry of External Affairs

Passport Application Form (No.1)
(For New / Re-issue/ Replacement of Lost/Damaged Passport)
Paste your
unsigned recent
colour
photograph.
Size: 3.5 X 3.5 cm
(Please tick the required category)

Signature
OR
Thumb Impression

Please read the Passport Information Booklet carefully before filling the form, in CAPITAL
LETTERS in blue/ black ball point pen only:
(CAUTION: Please furnish correct information. Furnishing of incorrect information would attract
penal provisions as prescribed under the Passports Act, 1967). Please produce your original
documents at the time of submission of the form.
)RURIILFLDOXVHRQO\
File Number .............. Police Verification required (Yes/No) ECR / ECNR
.............
Signature oI Checking OIIicial
Fee Amount Rs. Cash /D.D Bank Code D.D No. Date oI Issue oI D.D


1. Name oI applicant as it should appear in the Passport (Initials not allowed)


Surname
Given Name
(with documentary
prooI)

2. In case oI change oI name/surname (aIter marriage or otherwise with documentary prooI), please indicate
the previous name/surname in Iull


3. Sex
Male Female Others

4. Date oI Birth: DD MM YYYY
(with documentary prooI)
In words.

5. Place oI Birth: Village / Town, District, State, Country (with Documentary ProoI)


6. Father/Legal Guardian's Full Name (including surname, iI any): (Initials not allowed)


7. Mother`s Full Name (including surname, iI any): (Initials not allowed)


8. II married, Full Name oI wiIe/husband (including surname, iI any). (Initials not allowed).








(1)










8 (i) II divorced/widow/widower, Please indicate the category with documentary prooI.


9. Current Residential Address (where staying presently), Residing since .............
(In case oI students, please see Section III oI Passport InIormation Booklet)


P I N
Telephone No. Mobile No.


9 (a) II you have been resident at your current address Ior less than one year, please Iurnish other addresses
oI your residence during the last one year.
From.......To........ From.......To.......





10. Permanent Address with PIN code (iI the permanent address is same as the present address write 'Same
only)


P I N

11. Details oI latest held/existing Ordinary / Diplomatic / OIIicial passport(s):

(i) Passport OIIice File No: ........../ Passport(s) No.................
(ii) Date and Place oI Issue: ........../ Date oI Expiry ..............
(iii) In case passport was applied Ior and not issued, please give File No. & Date .........
(iv) Has your passport(s) ever been lost / damaged (iI so attach FIR and give details).........
.........................................

11. (a) II you have returned to India on Emergency CertiIicate (EC) or were ever deported or repatriated,
please Iurnish details:

EC No., date and place oI issue & attach seizure memo in original ................

Place & Country Irom where deported / repatriated and reason thereoI:.............
....................... .....................
.........................................

12. Other Details:
a) Educational QualiIications..............................

b) Visible Distinguishing Mark, iI any...........................

c) Height .......cms.
(2)



13. Are you working in Central Government/ State Govt/ PSU/ Statutory Bodies (Y)es/ (N)o
II Yes` attach Identity CertiIicate (As per Annexure 'B oI Passport InIormation booklet).

14. Are you a citizen oI India by: (B)irth/(D)escent/(R)egistration/(N)aturalisation; ..........
II you have ever possessed any other citizenship, please indicate previous citizenship .........

15. 'Emigration Check Not Required status? Yes/No .......
(Please note that all 10 and above qualified applicants are eligible for ECNR status.)
II yes, mention the eligible category (see Section III oI Passport InIormation Booklet) and enclose copy
oI relevant certiIicate/document



16. In case oI minors (applicant below the age oI 18), iI EITHER oI the parents hold a Valid Indian
Passport or has applied Ior it give the Iollowing details. Please see and Iill up attached Annexure-H.

Passport/ File No. Date & Place oI Issue/ Application
Mother

Father

17. (a) Have you at any time during the period oI Five years immediately preceding the date oI this
application been convicted by a court in India Ior any criminal oIIence & sentenced to imprisonment
Ior two years or more? II so, give name oI the court, case number and relevant sections oI Law.
(Attach copy oI judgement)
..........................................

(b) Are any criminal proceedings pending against you beIore a court in India? II so, give name oI court,
case number and relevant sections oI Law.
..........................................

(c) II answer at (b) is (Y)es, please Iurnish No Objection CertiIicate Irom competent court Ior grant oI
Passport.
........................................
.........................................

(d) Have you been ever reIused/denied passport? II yes, give details:
..........................................
..........................................


(e) Has your passport ever been impounded / revoked? II yes, give details:
..........................................
..........................................

(I) Have you ever applied/granted political asylum by any Ioreign country? II yes, give details.
..........................................
..........................................

18. Particulars oI person to be intimated in the event oI death or accident:
Name ...................................
Address ...................................
...................................
Mobile / Tel. No. / email ID ............................




(3)



19. SelI Declaration:

I owe allegiance to the sovereignty, unity & integrity oI India, and have not voluntarily
acquired citizenship or travel documents oI any other country. I have not lost, surrendered or been deprived
oI citizenship oI India. The inIormation given by me in this Iorm and enclosures is true and I am solely
responsible Ior its accuracy. I am aware that it is an oIIence under the Passports Act, 1967 to Iurnish any
Ialse inIormation or to suppress any material inIormation with a view to obtaining a passport or any other
travel document.

I Iurther declare that I have no other passport/ travel document.

(Signature/Thumb Impression of Applicant)
Date ..... (LeIt Hand Thumb Impression iI male and Right
Hand Thumb Impression iI Iemale)
Place ....

20. Enclosures:

1 ProoI oI date oI birth ........... 2 ProoI oI Residence ............

3 Educational QualiIications ........ 4 .......................

5 ................... 6 ..................


(For OIIicial Use Only)


Checked by Name Signature/date


Granted by Name Signature/date



Scanned by Name Signature/date



Dispatched by Name Signature/date













(4)




PERSONAL PARTICULARS FORM
(In Duplicate)

1. Full name (Initials not allowed) ........................... ....
..........................................

2. Sex: Male / Female / Others .............

(a) Has the applicant ever changed name?
(b) II yes, previous name: ................................

4. Date oI Birth:............. 5. Place oI Birth ................

6. ProIession .......................................

7. a) Father .......................................
(Surname) (Name)
b) Mother.......................................
(Surname) (Name)
c) Husband / wiIe .................................. .
(Surname) (Name)

8 a) Permanent Address & Tel. No. 8(b) Present Residential Address & Tel. No, along with
along with Police Station Police Station and residing since
................... ....................
................... ....................
................... ....................

9. II you have not been resident at the address given at COLUMN 8(b) continuously Ior the last one year,
please Iurnish other address(es) with duration(s) resided (Please Iurnish an additional set oI P P Forms
Ior each address with Police station.
From.......To........ From.......To.......





10. References: Names and Addresses oI two responsible persons in the applicant`s locality who can vouch
Ior the applicant.
(1) Name, Address & Tel. No. (2) Name, Address & Tel. No.
................... ....................
................... ....................
................... ....................

11. Citizenship oI India by: Birth Descent Registration Naturalization

12. Furnish details oI previous passport / travel document, iI any:
(i) Passport/Travel document No: ........... (ii) Date & Place oI issue .........



Signature or Thumb Impression of the applicant
(LeIt Hand T.I. iI male and Right Hand T.I. iI Iemale)


(5)


For Police Use Only


Recommended Passport: YES/NO
Paste your
cross signed
recent colour
photograph.
size 3.5*3.5 cm




PERSONAL PARTICULARS FORM
(In Duplicate)

1. Full name (Initials not allowed) ........................... ....
..........................................

2. Sex: Male / Female / Others .............

(a) Has the applicant ever changed name?
(b) II yes, previous name: ................................

4. Date oI Birth:............. 5. Place oI Birth ................

6. ProIession .......................................

7. a) Father .......................................
(Surname) (Name)
b) Mother.......................................
(Surname) (Name)
c) Husband / wiIe .................................. .
(Surname) (Name)

8 a) Permanent Address & Tel. No. 8(b) Present Residential Address & Tel. No, along with
along with Police Station Police Station and residing since
................... ....................
................... ....................
................... ....................

9. II you have not been resident at the address given at COLUMN 8(b) continuously Ior the last one year,
please Iurnish other address(es) with duration(s) resided (Please Iurnish an additional set oI P P Forms
Ior each address with Police station.
From.......To........ From.......To.......





10. References: Names and Addresses oI two responsible persons in the applicant`s locality who can vouch
Ior the applicant.
(1) Name, Address & Tel. No. (2) Name, Address & Tel. No.
................... ....................
................... ....................
................... ....................

11. Citizenship oI India by: Birth Descent Registration Naturalization

12. Furnish details oI previous passport / travel document, iI any:
(i) Passport/Travel document No: ........... (ii) Date & Place oI issue .........



Signature or Thumb Impression of the applicant
(LeIt Hand T.I. iI male and Right Hand T.I. iI Iemale)


(5)


For Police Use Only


Recommended Passport: YES/NO
Paste your
cross signed
recent colour
photograph.
size 3.5*3.5 cm