File Number (For Office Use Only)

GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS
PASSPORT APPLICATION FORM

Please read the Passport Instruction Booklet carefully before filling the form. 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.
1. Service Required
1.1 Applying for
Fresh Passport
Re-issue of Passport
1.2 If re-issue, specify reason(s)
Validity Expired within 3 years/ Due to Expire
Validity Expired more than 3 years ago
Change in Existing Personal Particulars
Exhaustion of Pages
Lost Passport
Damaged Passport
1.3 If change in existing personal particulars, specify reason(s)
Appearance
Date of Birth
Others, Please specify
Signature
Spouse Name
Given Name
Address
Surname
Delete ECR
1.4 Type of Application
Normal
Tatkaal
60 Pages
36 Pages
1.5 Type of Passport Booklet
Up to age 18
10 Years
1.6 Validity Required
(For minors between 15 and 18 years)
Please paste your unsigned recent colour photograph with white background of size 4.5cm X 3.5cm. [Not needed for applicants submitting the application at Passport Seva Kendra]
Signature/ Left Hand Thumb Impression of Illiterate Applicant and Minors who cannot sign.
2. Applicant Details
Surname
No
Yes
2.2 Are you known by any other names (aliases)?
If yes, provide details in Column 1 of Supplementary Form
If yes, provide details in Column 2 of Supplementary Form
No
Yes
2.3 Have you ever changed your name?
2.1 Applicant's Given Name (Given Name means First name followed by Middle name (If any))(Initials not allowed)
Country (If born abroad) If born before 15/08/1947 in a place now in Pakistan or Bangladesh, write "Undivided India"
Female
Male
2.6 Gender
Married
Single
2.7 Marital Status
Divorced
Widow/ Widower
Separated
Registration/ Naturalization
Descent
Birth
2.8 Citizenship of India by
2.10 Voter ID (If available)
Government
2.11 Employment Type
Self Employed
Others
Statutory Body
Homemaker
Owners, Partners & Directors of companies which are members of CII, FICCI & ASSOCHAM
PSU
Not Employed
Retired Government Servant
Retired-Private Service
Private
Student
2.13 Is either of your parent (in case of minor)/ spouse, a government servant?
No
Yes
Between 6th and 9th Standard
5th pass or less
2.14 Educational Qualification
10th pass and above
Graduate and above
No
Yes
2.15 Are you eligible for Non-ECR category?
For details, see Column 2.15, section B of Instruction Booklet
District (If born in India)
State/ UT (If born in India)
2.12 If employed in Government/ Statutory Body/ PSU, specify organization name
2.9 PAN (If available)
2.16 Visible Distinguishing Mark
2.5 Place of Birth (Village or Town or City)
2.4 Date of Birth (DD-MM-YYYY)
3. Family Details
-
-
2.17 Aadhaar Number
3.4 Spouse's Given Name (Given Name means First name followed by Middle name (If any)) (Initials not allowed)
3.5 If applicant is minor, provide following details
Parent's Passport Details
(If passport has been applied for but not received, give File Number)
Father/ Legal Guardian's File/ Passport Number
Mother/ Legal Guardian's File/ Passport Number
Father/ Legal Guardian's Nationality, if not Indian
Mother/ Legal Guardian's Nationality, if not Indian
4. Present Residential Address Details (Where applicant presently resides)
4.1 Residing Since (MM-YYYY)
-
3.3 Legal Guardian's Given Name (If applicable) (Initials not allowed)
3.2 Mother's Given Name (Given Name means First name followed by Middle name (If any)) (Initials not allowed)
3.1 Father's Given Name (Given Name means First name followed by Middle name (If any)) (Initials not allowed)
Surname
Surname
Surname
Surname
If you have been residing at your present residential address for less than one year, mention the previous address(es) in Column 3 of SupplementaryForm. If you are on a temporary visit to India, fill Column 5 of Supplementary Form.
PIN
E-mail ID
4.3 Is permanent address same as present address?
If no, provide details in Column 4 of Supplementary Form
No
Yes
5. Emergency Contact Details
Name and Address (Mention address only if different from present residential address)
Mobile Number Telephone Number
E-mail ID
Police Station
State/ UT
4.2 House No. and Street Name
Village or Town or City
District
Mobile Number Telephone Number
Place of Issue
Telephone Number
Mobile Number
Date of Expiry (DD-MM-YYYY)
Date of Issue (DD-MM-YYYY)
Passport Number
7.1 Details of latest held/ existing/ lost/ damaged ordinary passport
7. Previous Passport/ Application Details
If yes, provide the following details
If you have held/ hold any diplomatic/ official passport, provide details in Column 6 of Supplementary Form
7.2 Have you ever applied for passport, but not issued?
No
Yes
Month and Year of applying
File Number
-
Name of passport office where applied
8.1 Have you ever been charged with criminal proceedings or any arrest warrant/ summon pending before a court in India? If yes, fill Column 7.1 of Supplementary Form
8. Other details
No
Yes
6.2 Second Reference Name and Address
6. References in your Village or Town or City
6.1 First Reference Name and Address
Telephone Number
Mobile Number
-
-
-
-
Page 6 of 6
11. 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 and I affirm that the information given by me in this form and the enclosures is true and I am solely responsible for its accuracy, and 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.
Place
Date (DD-MM-YYYY)
Signature/ Left Hand Thumb Impression of Applicant (If applicant is minor, either parent to sign)
Branch
10. Enclosures
1.
2.
3.
4.
6.
7.
8.
9.
10.
DD Expiry Date
Bank Name
9. Fee Details (Not to be filled by applicants submitting the application at Passport Seva Kendra)
9.2 If paid by Demand Draft (DD), provide the following details
9.1 Fee amount in (Rs)
DD Number
DD Issue Date
8.6 Have you ever returned to India on Emergency Certificate (EC) or were ever deported or repatriated? If yes, provide details in Column 7.6 of Supplementary Form
8.5 Have you ever applied for/ been granted political asylum to/ by any foreign country? If yes, provide details in Column 7.5 of Supplementary Form
8.4 Has your Passport ever been Impounded or Revoked? If yes, provide details in Column 7.4 of Supplementary Form
8.3 Have you ever been refused or denied passport? If yes, give reason for refusal or denial of Passport in Column 7.3 of Supplementary Form
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
8.2 Have you at any time during the period of 5 years immediately preceding the date of this application been convicted by a court in India for any criminal offence & sentenced to imprisonment for two years or more? If yes, fill Column 7.2 of Supplementary Form