Passport Application Form
Personal Details
Given Name:
*
Surname:
*
Aliases,if any:
*
Previous Name:
*
Gender:
*
select
Male
Female
Date of Birth( eg '1984-06-24'):
*
Phone:
*
Mobile:
*
Email:
*
Place of Birth:
*
Height(in Cm):
Colour of Eyes:
Colour of Hair:
Visible Marks:
Permanent Address (In India):
*
Present Address (In Singapore):
*
Family Details
Father's Name:
*
Father's Birth Country:
*
Mother's Name:
*
Mother's Birth Country:
*
Nationality of Father at the time of Applicant's Birth:
*
Nationality of Mother at the time of Applicant's Birth:
*
Marital Status:
*
--Select--
MARRIED
UNMARRIED
Spouse's Name:
*
Spouce Nationality:
*
Passport & Other ID Details
Passport No:
Date of Issue:
Date of Expiry:
Place of Issue:
Edu. Qualifications:
When did Applicant first leave India:
When was he/she in India last:
How long has applicant continuously resided abroad:
Present Emigration Status with documentary evidence:
Select
ECR
ECNR
Profession:
Business Address:
Business Phone:
Citizen of India By:
Select
BIRTH
DESCENT
NATURALIZATION
REGISTRATION
Did applicant ever possess any other nationality or travel document of any other country? If so, please give details? :
Select
YES
NO
Was applicant ever refused an Indian Passport?:
Select
YES
NO
Was applicant's passport ever impounded/revoked? If so, details please:
Name and address of two relatives/friends
Name (In India):
Address:
Phone:
*
Name (In Singapore):
Address:
Phone:
*
Are any criminal proceedings pending against applicant in a court in India? If so, please give Details:
Has applicant ever been repatriated from abroad to India at the expenses of the Govt. of India? If so, details please:
Lost/Damaged Passport Details
Passport No:
Place of Issue:
Date of Issue:
Valid Until:
Briefly state circumstances of loss/theft/damage of passport on a plain paper and attach copy of report lodged with local police in case of loss/theft:
Give details of restriction, if any, imposed on applicant's damaged/lost passport:
Did applicant avail transfer of residence, foreign travel scheme facility on lost/damaged passport ? if so , details please:
Declaration
Sign Place:
I HAVE READ AND AGREED TO THE FOLLOWING TERMS AND CONDITIONS
Enter Code :