GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS
PCC APPLICATION FORMS

Please read the Passport Instruction Booklet carefully before filling the form. Fill this form in CAPITAL LETTERS.
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. All fields marked with (*) are mandatory to fill.
Passport Number *
Date of Issue (DD/MM/YYYY) * Date of Expiry (DD/MM/YYYY) *
Place of Issue *
Country for which PCC is required *
Applicant Details
Applicant's Given Name (Given Name means First name followed by Middle name (if any))(Initials not allowed) *
Surname
Date of Birth (DD/MM/YYYY) *
Village or Town or City *
Gender * Marital Status * Citizenship of India by *
Employment Type *
Educational Qualification * Aadhaar Number
Family Details (You have to provide atleast one Father/Mother/Legal Guardian details.) *
Father's Given Name (Given Name means First name followed by Middle name (if any))(Initials not allowed)
Surname
Mother's Given Name (Given Name means First name followed by Middle name (if any))(Initials not allowed)
Surname
Legal Guardian's Given Name (Given Name means First name followed by Middle name (if any))(Initials not allowed)
Surname
Present Residential Address Details
Residing Since * Month Year
House No and Street Name *
Village or Town or City *
Page 2 of 2
State/ UT *
District *
Police Station *
PIN * Mobile Number * Telephone Number
E-mail ID
Is permanent address same as present address? * Yes No
References in your Village or Town or City *
First Reference Name and Address *
Mobile Number Telephone Number
Second Reference Name and Address *
Mobile Number Telephone Number
Other Details
Any criminal proceedings pending against you before any court in India? * Yes No
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 the citizenship of India and I affirm that the information given by me in this form and the enclosures is true and I solely responsible for its accuracy, and I am liable to be penalized or prosecuted if found otherwise. I am aware that under the Passport 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.
I agree
Place * Date (DD/MM/YYYY) *