9/18/22, 9:09 PM Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 22-1010815801
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet JUMBO
Applicant Details
Applicant's Name LIKHITHA GANGAM
Date of Birth (DD/MM/YYYY) 03/02/1998
Validity Required NA
Place of Birth (Village/Town/City) KARIMNAGAR
District KARIMNAGAR
State/UT TELANGANA
Region/Country INDIA
Gender FEMALE
Marital Status SINGLE
Citizenship of India by BIRTH
Employment Type STUDENT
Is either of your parent (in case of minor)/spouse, a government
N
servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? N
Aadhaar Number 732875600561
Family Details
Father's Name LAXMA REDDY GANGAM
Mother's Name JYOTHI GANGAM
Present Residential Address Details
Address 5-43/2, HUSNABAD, KARIMNAGAR, TELANGANA
PIN 505467
Police Station KARIMNAGAR I TOWN
Mobile/Tel No. 8179233138
E-mail [email protected]
Permanent Residential Address
Address 5-43/2, HUSNABAD, KARIMNAGAR, TELANGANA
PIN 505467
Police Station KARIMNAGAR I TOWN
Mobile/Tel No. 8179233138
Emergency Contact Details
GANGAM LAXMA REDDY,HUSNABAD,KARIMNAGAR NO-5-
Name and Address
43/2,H
Mobile/Tel No. 08179233138
E-mail [email protected]
Other Details
Enclosures
1.Aadhaar Card/E-Aadhaar
2.Aadhaar Card (Address Proof)
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

https://portal2.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 1/2
9/18/22, 9:09 PM Application Form
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 HYDERABAD
Date 18/09/2022
Print Close

https://portal2.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 2/2