External Affairs Information

File Number (For Office Use Only)

Service Required

Application Reference Number 25-100*******

Applying For FRESH

Type of Application NORMAL

Type of Passport Booklet NORMAL

Applicant Details

Applicant's Name SUBHAJIT MANNA

Date of Birth (DD/MM/YYYY) 05/01/2000

Validity Required NA

Place of Birth (Village/Town/City) KOLKATA

District KOLKATA

State/UT WEST BENGAL

Region/Country INDIA

Gender MALE

Marital Status SINGLE

Citizenship of India by BIRTH

PAN FLNPM4827E

Employment Type NOT EMPLOYED

Is either of your parent (in case of

minor)/spouse, a government servant?

N

Educational Qualification GRADUATE AND ABOVE

Are you eligible for Non-ECR category? Y

Aadhaar Number 873*********

GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS

PASSPORT APPLICATION FORM

Please read the Passport Instruction Booklet carefully before filling the form. Fill this form in CAPITAL LETTERS using blue/black ink ball point pen only. Furnishing of incorrect information/ suppression of information would lead to rejection of the application and would attract penal provisions as prescribed under the Passports Act, 1967. Please produce your original documents at the time of submission of the form.

Signature/Left Hand Thumb Impression

of Illiterate Applicant and Minors who

cannot sign.

Family Details

Father's Name SALIL KUMAR MANNA

Mother's Name JHUMUR MANNA

Present Residential Address Details

Address

1ST FLOOR,B-44 GANGANAGAR, MUKUNDAPUR, KOLKATA,

KOLKATA, WEST BENGAL

PIN 700099

Police Station JADAVPUR

Mobile/Tel No. 947-***-****

E-mail ********.****@*****.***

Permanent Residential Address

Address

1ST FLOOR,B-44 GANGANAGAR, MUKUNDAPUR, KOLKATA,

KOLKATA, WEST BENGAL

PIN 700099

Police Station JADAVPUR

Mobile/Tel No. 947-***-****

Emergency Contact Details

Name and Address SALIL KUMAR MANNA, KOLKATA

Mobile/Tel No. 947-***-****

E-mail ***************@*****.***

Other Details

Payment Details

Mode of Payment UPI

Date 07/03/2025

Receipt/Reference No. CPAEWWYER4

Amount Received (Rs.) 1500.00 (ONE THOUSAND FIVE HUNDRED ONLY) Enclosures

1.Permanent Account Number Card issued by the Income-tax Department having the date of birth of the applicant 2.Aadhaar Card (Address Proof)

Self Declaration

I owe allegiance to the sovereignty, unity & 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. I have not contravened any of the conditions relating to the possession and use of an Indian passport. I affirm that the information and particulars given by me in this form are true and correct. I further state that I am not suppressing any material information in this regard. I further affirm that the enclosures and documentary proof submitted in support of my application for an Indian passport are authentic and solely pertain to me and I am fully responsible for the accuracy of the same. 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. I have read and understood the contents of the above and by submitting this form certify that all the information submitted by me in the form is bonafide.

Place KOLKATA

Date 07/03/2025

Signature/Left Hand Thumb Impression of

Applicant (If applicant is minor, either parent

to sign)

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