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Applying For FRESH Type of Application NORMAL Type of Passport Booklet NORMAL Applicant Details Applicant's Name DARSHAN

J DONGRE Date of Birth (DD/MM/YYYY) 20/10/1988 Place of Birth (Village/Town/City) DHULE District DHULE State/UT MAHARASHTRA Country INDIA Gender MALE Marital Status SINGLE Citizenship of India by BIRTH PAN AYTPD5519L Employment Type NOT EMPLOYED Is either of your parent (in case of minor)/ spouse, a government servant? N Educational Qualification 10TH PASS AND ABOVE Are you eligible for Non-ECR category? Y

Father's Name JAGADISH DONGRE Mother's Name SUMA DONGRE Present Address Details Residing Since(MM/YYYY) 06/1999 Address 132, 3RD CROSS KAVERI NAGAR, MANDOLI ROAD BELGAUM KARNATAKA BELGAUM VADAGAON RURAL PIN 590006 Mobile/Tel No 8971014699 / 08312442842 Email darshan.dongre@gmail.com

First Reference Name And Address SHRIDHAR NATEKAR, 130 KAVERI NAGAR, MANDOLI ROAD BELGAUM 590006 Mobile/Tel No 9448850136 / 08312442739 Second Reference Name And Address KARAN B GAVALI, HOUSE NO 2038, PATIL GALLI, BHAVANI NAGAR, BELGAUM 590006 Mobile/Tel No 9538341372 Permanent Address Address 132, 3RD CROSS KAVERI NAGAR, MANDOLI ROAD BELGAUM KARNATAKA BELGAUM VADAGAON RURAL PIN 590006 Mobile/Tel No 8971014699 / 08312442842 Emergency Contact Details Name and Address SHRIDHAR NATEKAR, 130 KAVERI NAGAR 3RD CROSS, MANDOLI ROAD, BELGAUM Mobile/Tel No 9448850136 / 08312442739 Other Details
Place BELGAUM Date 23/02/2013

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