32/022/12021 AAPPPPLLIICCAATTIIOONN FFOORRMM FFOORR IINNDDIIAANNPPAASSSSPPOORRTT

SAMPLE ONLY
CONSULATE GENERAL OF INDIA
LEVEL 1, 2S6e5leCctAaSsT pL eErRJEuAriGs HdicStTioRnE, EATUSSTYRDANLEIYA, NSW 2000, AUSTRALIA
00-61-2-92232702, https://cgisydney.gov.in/
APPLICATION FORM FOR INDIAN PASSPORT

PASSPORT PREVIEW GGeenneerraatteedd OOnn::

230/22/12,052:10,15:2:231P:2M3 AM
भारत गणरा REPUBLIC OF INDIA
टाइप/Type राJ कोड/CountryCode पासपोट´
नं./PassportNo.

Paste your
unsigned recent उपनाम/Surname

color photograph As per current

passport
Size 2"X2" and
ि गया नाम/Given Name(s)
Signature/Left
As per current passport ज ितिथ/Date of
Hand Thumb राJ ीयता/Nationality ि
Birth
लंग/Sex
M/F As per passport
box provided below ज थान/Place of Birth

As per current passport

जारी करने का थान/Place of Issue
As per current
passport
Signature as per जारी करने की ितिथ/Date of समाि™ की ितिथ/Date of
Issue As per current Expiry
passport
passport

िपता/कानूनी अिभभावक का नाम/Name of Father/Legal Guardian

As per current passport

माता का नाम/Name of Mother

As per current passport

पित या प ी का नाम/Name of Spouse

As per current passport (If applicable)

पता/Address

As per current passport or if changed then enter new address

पुराने पासपोट´ का नं. और इसके जारी होने की ितिथ एवं थान/Old Passport No with Date
and Place of Issue
Enter old passport details

Note: Please paste your unsigned recent color photograph Size 2"X2" and Signature/Left Hand Thumb Impression in the box
provided above.

SERVICE REQUIRED
Application Reference Number 21-2000765746

Applying For
FFRREESSHHOR RE ISSUE If Re-issue, specify reason(s)
If change in existing personal particulars,
specify If other, specify

Type of Application NNOORRMMAALL (TATKAL NOT AVAILABLE)

Type of Passport Booklet 36 Pages

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APPLICANT DETAILS

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3/2/202 APPLICATION FORM FOR INDIAN PASSPORT
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Applicant's Name TAEs SpTer current passport
Applicant's Alias Name Y
Alias Name1 TEST TEST
Alias Name2 TESTTEST TEST
Applicant's Change In Name N
Previous
Name1
Previous
Name2

Date of Birth (DD/MM/YYYY) 0A5s/0p5e/r1c9u9r0rent passport

Validity Required NA

Place of Birth (Village/Town/City) MAsUpMeBr Ac uI rrent passport

District THANE CITY
State/UT MAHARASHTRA
Country INDIA

Gender

MAsAaLpEplicable Marital Status

Sample
SAsINaGppLlEicable Citizenship of India by BIRTH

PAN
Voter Id
Employment Type OTHERS
Organisation name
Is either of your parent (in case of minor)/spouse, a government
N
servant?

Educational Qualification
7ATsHapPpAliScaSblOeR LESS Are you eligible for Non-ECR category? N

Visible Distinguishing Mark NA

Aadhaar Number

FAMILY DETAILS
Father's Name TAEs SpTer

current passport Mother's Name TAEs SpTer

current passport Legal Guardian's Name TEST

Spouse's Name As per current passport (as applicable)

Father's Passport No
Father's Nationality
Mother's Passport No
Mothers's Nationality
PASSPORT PRINTABLE ADDRESS DETAILS

TAEs SpTer current passport (OR) if changed then enter new address
To be printed on passport
TEST, THANE
PIN:400601, MAHARASHTRA, INDIA
Mobile/Tel No. 1234567890

E-mail TEEntSeTr @yoGurMeAmILai.lCaOd Mdress

OTHER ADDRESS DETAILS
TE EntSerTyour Address in Australia
Addres TEST
s
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1 TEST, AUSTRALIA

Mobile/Tel No. 1E2n3te4r5y6o7u8r9c0ontact number

EMERGENCY CONTACT DETAILS
Name and Address TEST ( As applicable)

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3/2/202 APPLICATION FORM FOR INDIAN PASSPORT
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Mobile/Tel No. 1234567890
E-mail [email protected]
PREVIOUS PASSPORT
DETAILS OF LATEST HELD/EXISTING/LOST/DAMAGED immediately preceding the date of this application been
ORDINARY PASSPORT/ IDENTITY CERTIFICATE convicted by a court in India for any offence involving
Passport moral turpitude and sentenced in respect
thereof to imprisonment for not less than two
Number Date
years? Court Name and Place
of Issue Date
of Expiry Place
of Issue File
Number
HAVE YOU EVER APPLIED FOR PASSPORT, BUT NOT
ISSUED?
File Number
Date of Issue
Name of passport office where applied
DETAILS OF PREVIOUS/CURRENT
DIPLOMATIC/OFFICIAL PASSPORT
Passport

Sample
Number Date
of Issue Date
of Expiry Place
of Issue
1) Provide the following details if there are any criminal
proceedings pending against the applicant.
1.1)Are any proceedings in respect of an offence alleged to
have been committed by you pending before a criminal court
in India?
Court Name and Place
Case/FIR/Warrant Number
Law and Section(s)
1.2)Has any warrant or summons for your appearance been
issued and pending before a court under any law for the time
being in force?
Court Name and Place
Case/FIR/Warrant Number
Law and Section(s)
1.3)Has a warrant for your arrest been issued by a court
under any law for the time being in force?
Court Name and Place
Case/FIR/Warrant Number
Law and Section(s)
1.4)Has an order prohibiting your departure from India been
made by any court?
Court Name and Place
Case/FIR/Warrant Number
Law and Section(s)
2) Provide the following details if the applicant has been
convicted by a court in India.
2.1)Have you at any time during the period of five years
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1E nter your passport details
N

NE nter your passport details

Select below details as applicable

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Case/FIR/Warrant Number
Date of Conviction
3) Provide the following details if the applicant has been
refused/denied passport.
3.1)Have you ever been refused/denied passport?
N Reason for refusal or denial of passport
3.2)Has your passport ever been impounded?
N Passport Number
Reason for impounding/revocation
3.3)Has your passport ever been revoked?
N Passport Number
Reason for revocation
4) Provide the following details if applicant has applied
for or been granted foreign citizenship.
4.1)Have you ever applied for or been granted citizenship by
any other country?
N

Name of the country

Sample
4.2)Have you ever held the passport of any other country at any
time?
N Name of the country
4.3)Have you ever surrendered your Indian passport?
N Surrendered Indian passport number:
4.4)Have you ever applied for renunciation of Indian citizenship?
N Application Details:
Name of place where application submitted:
5) Provide the following details if applicant has returned
to India on Emergency Certificate.
5.1)Have you ever returned to India on Emergency Certificate
(EC)?
N EC No.
Date of Issue
Issuing
Authority
Country from where travelled on
EC/deported/repatriated Date of Return to India
Reason for issuing EC/deported/ repatriated
5.2)Have you ever been deported from any country? N
If yes, was the cost borne by the Government of India and if so,
has the same been refunded?
5.3)Have you ever been repatriated from any country back to India? N
If yes, was the cost borne by the Government of India and if so,
has the same been refunded?
SELF DECLARATION
I declare:

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.

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1 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

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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.

I understand:

That Ministry of External Affairs (MEA) (or its implementation partner agencies/stakeholders/third parties) may

undertake required checks to confirm the accuracy and authenticity of evidence I have provided and documents I

have submitted with this application. That the information I provide, including biometric data (if any), will be

treated in confidence, but it may be disclosed to other government departments,

agencies, local authorities, foreign governments, and other implementation

partner agencies/stakeholders/third parties to enable MEA or those bodies to perform their duties.

That providing biometric information, if collected as part of an application, is confirmation of my consent to getting

the biometric information checked to verify identity.

That the Passport and related services applications may be handled by the Indian Embassies/Consulates/

Passport Office/other offices including outside of the country in which I have applied and that this may involve

Sample
the transfer of my application and supporting documents to and from the respective offices.

That my details may, in certain circumstances, be passed to Police, Intelligence and other Fraud Detection &

Prevention agencies. I also understand that such agencies may provide related information about me to MEA.

PP ll aa cc ee
Signature/Left Hand Thumb Impression of
SYDNEY Applicant (If applicant is minor, either
parent to sign)
DD aa tt ee

02/03/2021

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