File Number (For Office Use Only)
GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS
PCC 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.
Passport Number
Date of Issue (DD-MM-YYYY) Date of Expiry (DD-MM-YYYY)
Signature/ Left Hand Thumb
- - - - Impression of Illiterate
Applicant and Minors who
Place of Issue cannot sign.
Country for which PCC is required
1. Applicant Details
1.1 Applicant's Given Name (Given Name means First name followed by Middle name (If any))(Initials not allowed)
Surname
1.2 Aadhaar Number
2. Family Details
2.1 Father's Given Name (Given Name means First name followed by Middle name (If any)) (Initials not allowed)
Surname
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2.2 Mother's Given Name (Given Name means First name followed by Middle name (If any)) (Initials not allowed)
Surname
2.3 Legal Guardian's Given Name (If applicable) (Initials not allowed)
Surname
2.4 Spouse's Given Name (Given Name means First name followed by Middle name (If any)) (Initials not allowed)
Surname
3. Present Residential Address Details
3.1 House No. and Street Name
Village or Town or City
District
Police Station
State/ UT
PIN
Mobile Number Telephone Number
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E-mail ID
3.2 Is permanent address same as present address? Yes No (If no, provide details in Column
4 below)
4. Permanent Residential Address (If it is different from present residential address)
House No. and Street Name
Village or Town or City
District
Police Station
State/ UT
Country
PIN
Mobile Number Telephone Number
E-mail ID
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5. Other details
5.1 Provide the following details if there are any criminal proceedings
pending against the applicant.
Yes No
5.1.1 Are any proceedings in respect of an offence alleged to have been
committed by you pending before a criminal court in India?
If yes, fill Column 6.1 below
5.1.2 Has any warrant or summons for your appearance been issued & pending
before a court under any law for the time being in force?
If yes, fill Column 6.2 below
5.1.3 Has a warrant for your arrest been issued by a court under any law for the
time being in force?
If yes, fill Column 6.3 below
5.1.4 Has an order prohibiting your departure from India been made by any
court?
If yes, fill Column 6.4 below
5.2 Provide the following details if the applicant has been convicted by a
court in India.
5.2.1 Have you, at any time during the period of five years immediately preceding
the date of this application, been convicted by a court in India for any offence
involving moral turpitude and sentenced in respect thereof to imprisonment
for not less than two years?
If yes, fill Column 6.5 below
6.1 Provide the following details if there are proceedings in respect of an offence alleged to have
been committed by you pending before a criminal court in India and attach written permission from
competent court.
Name of Court and Place
Case/ FIR/ Warrant Number
Law and Section(s)
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6.2 Provide the following details if there is any warrant or summons for your appearance been issued
& pending before a court under any law for the time being in force and attach written permission from
competent court.
Name of Court and Place
Case/ FIR/ Warrant Number
Law and Section(s)
6.3 Provide the following details if there is any warrant for your arrest been issued by a court under
any law for the time being in force and attach written permission from competent court.
Name of Court and Place
Case/ FIR/ Warrant Number
Law and Section(s)
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6.4 Provide the following details if there is an order prohibiting your departure from India been made
by any court and attach written permission from competent court.
Name of Court and Place
Case/ FIR/ Warrant Number
Law and Section(s)
6.5 Provide the following details if the applicant has been convicted by a court in India and attach
copy of judgement.
Name of Court and Place
Case/ FIR/ Warrant Number
Date of Conviction (DD-MM-YYYY)
- -
7. Enclosures
1. 6.
2. 7.
3. 8.
4. 9.
5. 10.
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8. 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.
I have not contravened any of the conditions relating to the possession and use of an Indian passport.
I affirm that the information and particulars given by me in this form are true and correct. I further state that I
am not suppressing any material information in this regard. I further affirm that the enclosures and documentary
proof submitted in support of my application for an Indian passport are authentic and solely pertain to me and
I am fully responsible for the accuracy of the same. 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.
I have read and understood the contents of the above and by submitting this form certify that all the
information submitted by me in the form is bonafide.
Place Signature/ Left Hand
Thumb Impression of
Applicant (If applicant is
minor either parent to
Date (DD-MM-YYYY)
sign)
- -
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