भारत गणराज्य/ Republic Of India

Layout

टाइप/Type

राष्ट्र कोड/Country Code

पासपोर्ट नं/Passport No.

उपनाम/Surname

दिया गया नाम/Given Name(s)

Layout (copy)

राष्ट्रीयता/Nationality

लिंग/Sex

Male
Female

जन्मतिथि/Date of Birth

जन्म स्थान/Place of Birth

जारी करने का स्थान/Place of Issue

Layout

जारी करने की तिथि/Date of issue

समाप्ति की तिथि//Date of Expiry

Applicant's Signature

पिता/कानूनी अभिभावक का नाम/Name of father/legal quardian

माता का नाम/Name of Mother

पति या पत्नी का नाम/Name of Spouse

पता/Address

पुराने पासपोर्ट का नं, और इसके जारी होने की तिथि एवं स्थान/Old Passport No with Date and Place of Issue

पुराने पासपोर्ट का नं, /Old Passport No

जारी होने की तिथि / Issue Date

स्थान//Place of Issue

Service Required

Application Reference Number

Applying For

If Re-issue, specify reason(s)

Type of Application

Type of Passport Booklet

Applicant Details

Applicant's Name

Applicant's Alias Name

Applicant's Change In Name

Date of Birth (DD/MM/YYYY)

Validity Required

Place of Birth (Village/Town/City)*

District

State/UT

Country

Gender

Male
Female

Marital Status

Citizenship Of India by

Employment Type

Is either of your parent (in case of minor)/spouse, a government servant?

Yes
No

Educational Qualification

Are you eligible for Non-ECR cateogry?

Yes
No

Visible Distinguishing Mark

Yes
No

Family Details

Father's Name

Mother's Name

Father's Passport No

Father's Nationality

Mother's Passport No

Mother's Nationality

Passport Printable Address Details

To be printed on passport

Mobile/Telephone Number

E-mail

Other Address Details

Address

Mobile/Telephone Number

Emergency Contact Details

Name and Address

Mobile/Telephone Number

Email

Previous Passport

Passport Number

Date of Issue

Date of Expiry

Place of Issue

File Number

Have you ever applied for passport, but not issued?

Yes
No

Details of Previous/Current Diplomatic/Official Passport

Yes
No