Scribd
Upload
80 views

Application Form PDF

This document is a passport application form for Venkata Jagadesh Sai Datta Nandikonda from Visakhapatnam, Andhra Pradesh. The application is for a fresh normal passport. Key details provided include the applicant's personal information like name, date of birth, address, contact details, and family details. References and current and permanent addresses are also listed. The applicant declares that the information provided is true and acknowledges legal penalties for supplying false information.

Uploaded by

Sai Charan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
80 views

Application Form PDF

This document is a passport application form for Venkata Jagadesh Sai Datta Nandikonda from Visakhapatnam, Andhra Pradesh. The application is for a fresh normal passport. Key details provided include the applicant's personal information like name, date of birth, address, contact details, and family details. References and current and permanent addresses are also listed. The applicant declares that the information provided is true and acknowledges legal penalties for supplying false information.

Uploaded by

Sai Charan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

2/2/2017 Application Form

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 17­1001339717
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name VENKATA JAGADESH SAI DATTA NANDIKONDA
Date of Birth (DD/MM/YYYY) 27/04/1993
Validity Required NA
Place of Birth (Village/Town/City) VISAKHAPATNAM
District VISAKHAPATNAM URBAN
State/UT ANDHRA PRADESH
Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
PAN AJFPN8483L
Employment Type NOT EMPLOYED
Is either of your parent (in case of
N
minor)/spouse, a government servant?
Educational Qualification GRADUATE AND ABOVE
Are you eligible for Non­ECR category? Y
Visible Distinguishing Mark A MOLE ON THE LEFT CHEEK
Aadhaar Number 380614091803
Family Details
Father's Name SATYANARAYANA NANDIKONDA
Mother's Name ANURADHA NANDIKONDA
Present Residential Address Details
Residing Since(MM/YYYY) 07/1993
D.NO 37­3­87/2,GAJAPATHI NAGAR,KANCHARAPALEM, VISAKHAPATNAM,
Address
KANCHARA, VISAKHAPATNAM URBAN, ANDHRA PRADESH
PIN 530008
Mobile/Tel No. 9493977473
E­mail [email protected]
First Reference Name And Address NAMMI MALLESWARA RAO,D.NO 37­3­87/2,HAJAPATHI NAGAR,VISAKHAPATNAM
Mobile/Tel No. 7032220448
V V MURALI KRISHNA,D.NO­37­3­87 ,GAJAPATHI
Second Reference Name And Address
NAGAR,KANCHARAPALEM,VISAKHAPATNAM­08
Mobile/Tel No. 9000625565
Permanent Residential Address
D.NO 37­3­87/2,GAJAPATHI NAGAR,KANCHARAPALEM, VISAKHAPATNAM,
Address
KANCHARA, VISAKHAPATNAM URBAN, ANDHRA PRADESH
PIN 530008
Mobile/Tel No. 9493977473
Emergency Contact Details
N.SATYANARAYANA,D.NO 37­3­87/2,GAJAPATHI
Name and Address
NAGAR,KANCHARAPALEM,VISAKHAPATNAM­08
Mobile/Tel No. 9866530881
Mobile/Tel No. 9866530881
Other Details
Self Declaration
I owe allegiance to the sovereignty, unity and 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 and I affirm that the information given by
me in this form and the enclosures is true and I am solely responsible for its accuracy, and 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.
Place VISAKHAPATNAM
Date 02/02/2017

https://portal2.passportindia.gov.in/AppOnlineProject/secure/ApplicantSelfDeclarationAction 1/1

You might also like