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.
Service Required
Application Reference Number 22-0005203508
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name DRISHTI AKASH GARG
Previous Name1 DRISHTI
Previous Name2 AGGARWAL
Date of Birth (DD/MM/YYYY) 08/06/1996
Validity Required NA
Place of Birth (Village/Town/City) DELHI
District SOUTH DELHI
Signature/Left Hand Thumb Impression
State/UT DELHI
of Illiterate Applicant and Minors who
Region/Country INDIA cannot sign.
Gender FEMALE
Marital Status MARRIED
Citizenship of India by BIRTH
Employment Type HOME MAKER
Is either of your parent (in case of
N
minor)/spouse, a government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non-ECR category? N
Aadhaar Number 399217699623
Family Details
Father's Name SHRIKANT AGGARWAL
Mother's Name ABHA AGGARWAL
Spouse's Name AKASH GARG
Present Residential Address Details
4/94 B VIJAYANT KHAND, GOMTI NAGAR, LUCKNOW,
Address
LUCKNOW, UTTAR PRADESH
PIN 226010
Police Station GOMTI NAGAR
Mobile/Tel No. 9118008011
E-mail [email protected]
Permanent Residential Address
4/94 B VIJAYANT KHAND, GOMTI NAGAR, LUCKNOW,
Address
LUCKNOW, UTTAR PRADESH
PIN 226010
Police Station GOMTI NAGAR
Mobile/Tel No. 9118008011
Emergency Contact Details
Name and Address DRISHTI
Mobile/Tel No. 9118008011
Other Details
Payment Details
Mode of Payment UPI
Date 11/04/2022
Receipt/Reference No. CPABOHVYQ8
Amount Received (Rs.) 1500.00 (ONE THOUSAND FIVE HUNDRED ONLY)
Enclosures
1.Aadhaar Card/E-Aadhaar
2.Spouse's passport copy (First and last page including family details)
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 LUCKNOW Signature/Left Hand Thumb Impression of
Applicant (If applicant is minor, either parent
Date 11/04/2022 to sign)
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