6/10/25, 8:50 PM ViewPrintApplicationReceipt
File Number (For Office Use Only)
Ministry of External Affairs, Government of India
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 - 25-1051573511 Please paste
Number your unsigned
Applying For
Type of Application -
- FRESH
NORMAL
recent color
photograph of
Type of Passport - JUMBO size 4.5cm *
Booklet 3.5cm.
Applicant Details
Applicant's Name - VIJAYA HASINI KAVATARAPU
Date of Birth
(DD/MM/YYYY) - 06/08/2008
Validity Required - 10 Years
(Village/Town/City) -
Place Of Birth VIJAYAWADA Signature/Left Hand Thumb
Impression of Illiterate Applicant
and Minors who cannot sign.
District - KRISHNA
State/UT - ANDHRA PRADESH
Region/Country - INDIA
Gender - FEMALE
Marital Status -
Citizenship of India by -
SINGLE
BIRTH
Employment Type - STUDENT
Is either of your parent- N
(in case of
minor)/spouse, a
government servant?
Educational
Qualification - 10TH PASS AND ABOVE
Are you eligible for - Y
Non-ECR category
Aadhaar Number - 618503713343
Family Details
Father Name - SUDHAKAR KAVATARAPU
Mother Name - VENKATA ANJALI KAVATARAPU
Present Residential Address Details:
Address - 12-1716/3, TADEPALLE, GUNTUR, ANDHRA PRADESH
Pin - 522501
Police Station - TADEPALLI
Mobile/Tel No - 7660865666
Email -
[email protected] Permanent Residential Address Details
Address - 12-1716/3, TADEPALLE, GUNTUR, ANDHRA PRADESH
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6/10/25, 8:50 PM ViewPrintApplicationReceipt
Pin 522501
Police Station - TADEPALLI
Mobile/Tel No - 7660865666
EmergencyContactDetails:
Name and Address - KAVATARAPU SUDHAKAR
Mobile/Tel No. - 9948611114
E-mail -
[email protected] Previous Passport
Other Details
Fee Details (Not to be filled by applicants submitting the application at Passport Seva
Kendra/Passport Office)
Fee amount in (Rs) -
If paid by Demand Draft(DD), provide the following details
DD Issue Date (dd/mm/yyyy) -
DD Expiry Date (dd/mm/yyyy) -
Bank Name -
Branch -
Enclosures:
1. Aadhaar Card (Address Proof)2. Birth certificate issued by the Registrar of Births and Deaths or the Municipal
Corporation or any other authority, empowered under the Registration of Births and Deaths Act, 1969 (18 of
1969)
3. A declaration affirming the particular furnished in the application about the minor as per AnnexureC
4. A declaration affirming the particular furnished in the application about the minor as per AnnexureD
5. A declaration affirming the particular furnished in the application about the minor as per AnnexureI
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 - VIJAYAWADA Signature/Left Hand Thumb
Date - 13/05/2025 Impression of Applicant (If applicant
is minor, either parent to sign)
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