Application Form 10/01/19, 11'50 PM

PASSPORT APPLICATION FORM

Government of INDIA, Ministry of External Affairs

Service Required
Application Reference Number 19-1000355135
Applying For FRESH
Type of Application NORMAL
Type of Passport Booklet NORMAL
Applicant Details
Applicant's Name UDAY SAI KUMAR PONNAMANDA
Date of Birth (DD/MM/YYYY) 04/03/1998
Validity Required NA
Place of Birth (Village/Town/City) NARSAPUR
District WEST GODAVARI
State/UT ANDHRA PRADESH
Country INDIA
Gender MALE
Marital Status SINGLE
Citizenship of India by BIRTH
Employment Type STUDENT
Is either of your parent (in case of
N
minor)/spouse, a government servant?
Educational Qualification 10TH PASS AND ABOVE
Are you eligible for Non-ECR category? Y
Aadhaar Number 254229044789
Family Details
Father's Name NAGESWARA RAO PONNAMANDA
Mother's Name DAKSHAYANI PONNAMANDA
Present Residential Address Details
SASI INSTITUTE OF TECHNOLOGY&ENG,NEAR AERODROME, TADEPALLIGUDEM,
Address
TADEPALLIGUDEM TOWN, WEST GODAVARI, ANDHRA PRADESH
PIN 534101
Mobile/Tel No. 9494345589
E-mail UDAYSAIKUMAR1919@GMAIL.COM
Permanent Residential Address
1-59/2,MOGALTHUR MANDAL,CHINTAREVU ,MUTYALAPALLE, NARSAPUR,
Address
MOGALTUR, WEST GODAVARI, ANDHRA PRADESH, INDIA
PIN 534281
Emergency Contact Details
Name and Address NAGESWARA RAO PONNAMANDA
Mobile/Tel No. 9666263249
Other Details
Enclosures
1.Aadhaar Card/E-Aadhaar
2.Aadhaar Card/e-Aadhar containing the 12 digit Aadhaar number issued by the Unique Identification Authority of India(UIDAI)
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 TADEPALLIGUDEM

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Application Form 10/01/19, 11'50 PM

Date 10/01/2019

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