PASSPORT APPLICATION FORM
Government of INDIA, Ministry of External Affairs
Service Required
Application Reference Number 24-0019762736
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name VEENA PANDEY
Date of Birth (DD/MM/YYYY) 20/05/1977
Validity Required NA
Place of Birth (Village/Town/City) DEWAS
District DEWAS
State/UT MADHYA PRADESH
Region/Country INDIA
Gender FEMALE
Marital Status MARRIED
Citizenship of India by BIRTH
PAN CJPPP1827A
Employment Type HOME MAKER
Is either of your parent (in case of minor)/spouse, a
N
government servant?
Educational Qualification 7TH PASS OR LESS
Are you eligible for Non-ECR category? N
Aadhaar Number 853510890052
Family Details
Father's Name BABULAL KABRA
Spouse's Name DHEERAJ PANDEY
Present Residential Address Details
Address 81,GITA SHRI DREAM CITY, DEWAS, DEWAS, MADHYA PRADESH
PIN 455001
Police Station BAGLI
Mobile/Tel No. 9752495838
E-mail [email protected]
Permanent Residential Address
Address 81,GITA SHRI DREAM CITY, DEWAS, DEWAS, MADHYA PRADESH
PIN 455001
Police Station BAGLI
Mobile/Tel No. 9752495838
Emergency Contact Details
Name and Address DHEERAJ PANDEY
Mobile/Tel No. 9752495838
Other Details
Enclosures
1.PAN Card issued by the Income Tax Department
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 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 DEWAS
Date 27/11/2024
