Birthday

Government of India
Ministry of External Affairs
Passport Application Form (No.1)
(For New / Re-issue/ Replacement of Lost/Damaged Passport)
(Please tick the required category)

? ? O ?i i ? i i i i i

Paste your
unsigned recent
colour
photograph.
Size: 3.5 X 3.5 cm

Signature
±®
Thum? Impression
Please read the Passport Information Booklet carefully before filling the form, in CAPITAL
LETTERS in blue/ black ball point pen only:
(CAUTION: Please furnish correct information. Furnishing of incorrect information would attract
penal provisions as prescribed under the Passports Act, 1967). Please produce your original
documents at the time of submission of the form.
For official use only
File Number ……………………………….. Police Verification required

Fee Amount Rs.

Cash /D.D

e??

Bank Code

(Yes/No)

D.D No.

ECR / ECNR

…………………………………
Signature of Checking Official
Date of Issue of D.D

Y?IO

1. Name of applicant as it should appear in the Passport (Initials not allowed)
Surname

I?EUO?

Given Name

I?UO?E

(with documentary
proof)

2. In case of change of name/surname (after marriage or otherwise with documentary proof), please indicate
the previous name/surname in full

3. Sex

O ? OU

4. Date of Birth: ? i oO ? O oi ? i ?
(with documentary proof)
In words.________________________________________________
5. Place of Birth: Village / Town, District, State, Country (with Documentary Proof)

?ON ??O

?ON??O

6. Father/Legal Guardian’s Full Name (including surname, if any): (Initials not allowed)

I ? O O ?E I ? E U O ?
7. Mother’s Full Name (including surname, if any): (Initials not allowed)

?IEO? I?EUO?
8. If married, Full Name of wife/husband (including surname, if any). (Initials not allowed).

8 (i) If divorced/widow/widower, Please indicate the category with documentary proof.

I

?

U

O

?

E

I

?

E

U

O

?

9. Current Residential Address (where staying.