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    Application Form Passport Application Form Gov ernment of INDIA,Ministry of Externa l Affairs Se rv ice re qui re d Application Reference Number Applying For Type of Application Type of Passport Booklet Applicant De tai ls Applicant's Name Date of Birth (DD / MM / YYYY) Place of Birth (Village / Town / City) District Country Vellore INDIA ARUN NAKKEERAN 15

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    Application Form Passport Application Form Gov ernment of INDIA,Ministry of Externa l Affairs Se rv ice re qui re d Application Reference Number Applying For Type of Application Type of Passport Booklet Applicant De tai ls Applicant's Name Date of Birth (DD / MM / YYYY) Place of Birth (Village / Town / City) District Country Vellore INDIA ARUN NAKKEERAN 15

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    Attribution Non-Commercial (BY-NC)
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    671 views2 pages

    Application Form

    Uploaded by

    rajkumar_nitk
    Application Form Passport Application Form Gov ernment of INDIA,Ministry of Externa l Affairs Se rv ice re qui re d Application Reference Number Applying For Type of Application Type of Passport Booklet Applicant De tai ls Applicant's Name Date of Birth (DD / MM / YYYY) Place of Birth (Village / Town / City) District Country Vellore INDIA ARUN NAKKEERAN 15

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    Application Form https://portal2.passportindia.gov.in/wps/PA_PSPOnlineProject/popuponli...

    Passport Application Form

    Gov ernment of INDIA,Ministry of Ex terna l Affairs

    Se rv ice Re qui re d

    Application Reference Number 11-1725570

    Applying For FRESH

    Type of Application NORMAL

    Type of Passport Booklet NORMAL

    Applicant De tai ls

    Applicant's Name ARUN NAKKEERAN

    Date of Birth (DD/MM/YYYY) 15/09/1991

    Place of Birth (Village/Town/City) ARAKKONAM

    District Vellore State/UT Tamil Nadu

    Marital
    Country INDIA Gender MALE SINGLE
    Status

    Citizenship of India by BIRTH

    Employment Type STUDENT

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


    Y
    servant?

    Are you eligible for Non-ECR


    Educational Qualification 10TH PASS AND ABOVE N
    catagory?

    Visible Distinguishing Mark SCAR MARK BELOW RIGHT EYE

    Fam il y De tai ls

    Father's Name NAKKEERAN PONNUSWAMY

    Mother's Name REETA NAKKEERAN

    Pre se nt Addre ss De tai l s

    Residing Since(MM/YYYY) 07/2008

    A 007 MEGA TOWER III NITKS HOSTELS SRINIVASNAGAR


    Address
    SURATHKAL Karnataka Dakshina Kannada SURATHKAL

    PIN 575025

    Mobile/Tel No 9686422743

    Email aru91190@gmail.com

    RAJKUMAR MURUGESAN B002 MEGA TOWER III NITKS


    First Reference Name And Address
    HOSTELS SRINIVASNAGAR MANGALORE KARNATAKA

    Mobile/Tel No 9742020255

    VIBIN DEEPAK VASUDEVAN B004 MEGA TOWER III NITKS


    Second Reference Name And Address
    HOSTELS SRINIVASNAGAR MANGALORE KARNATAKA

    Mobile/Tel No 9972331987

    Pe rm ane nt Addre ss

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    Application Form https://portal2.passportindia.gov.in/wps/PA_PSPOnlineProject/popuponli...

    C/G/I/WEST PHASE II KAIGA TOWNSHIP MALLAPUR Karnataka


    Address
    Karwar INDIA MALLAPUR

    PIN 581400

    Mobile/Tel No 9483132894 / 08382255031

    Em e rg e ncy Contact De tai ls

    Name and Address p nakkeeran c/g/i/west phase ii

    Mobile/Tel No 9483132894 / 08382255031

    Othe r D e tai ls

    Se lf De cl aratio n

    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 SURATHKAL

    Date 28/01/2011

    2 of 2Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com) 28-01-11 8:48 PM

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