8/20/12

Application Form

Passport Application Government of India, Ministry of External Affairs Online Application Receipt
Applicant Details : Application Reference No 12-0001119177 Batch 23 Service Type REISSUE Type of Application Normal Sequence No. 19 Application Submitted Date05/08/2012 Date of Birth 12/02/1961 Reporting Time 03:30 PM Gender FEMALE Employment Type HOME MAKER Marital Status MARRIED Place of Birth FAIZABAD Given Name SHAHEDAH NASIR Surname SIDDIQUI Father's Name MOHAMMAD YUNUS KHAN Mother's Name KHATMUL NISHA Spouse's Name MOHAMMAD NASIR SIDDIQUI Present Address 4/4 DOCTORS RESIDENCE, BALRAMPUR HOSPITAL LUCKNOW LUCKNOW - 226018 UTTAR PRADESH , INDIA Applicants References : First Reference Details DR. B. P. BAJPAI, 4/2 DOCTORS RESIDENCE, BALRAMPUR HOSPITAL, LUCKNOW , 9450096728 Second Reference Details DR U. N. RAI, 1/1 DOCTORS RESIDENCE, BALRAMPUR HOSPITAL, LUCKNOW , 9415322462 Previous Passport Details : Old Passport No. A490920 Passport Issue Date 25/03/1991 Passport Expiry Date 24/03/2001 Place of Issue LUCKNOW Appointment Details : LUCKNOW, PSK Location RATAN SQUARE, 20-A, VIDHAN SABHA MARG, LUCKNOW-226001 Date & Time of 04/09/2012 & 03:45 PM Appointment Appointment ID 100002022968512 Reporting Time 03:30 PM
Note: Applicant should reach the Passport Seva Kendra by the reporting tim e m entioned above for pre-checking of docum ents to avoid any hassles in issuance of token. Only in the case of Senior Citizens, Physically Challenged, Illiterate Applicants and Minor cases, one accom panying person from the fam ily w ill be allow ed along w ith the applicant. Applicant w ill not be issued token at Passport Seva Kendra, if they report after scheduled appointm ent tim e. Minor applicants below 4 years of age need to carry a passport size photograph (w ith a w hite background) w hile visiting Passport Seva Kendra (PSK). Other applicants need not carry any photograph as photograph w ill be captured at the Passport Seva Kendra (PSK). Carrying of corrosive substances or explosives, arm s or any sharp objects w hich m ay cause physical harm or violence are prohibited inside the PSK. Electronic item s such as Laptop, iPad and cam eras are also prohibited inside the PSK. *ARN w ill be valid for 90 days.

https://portal1.passportindia.gov.in/AppOnlineProject/secure/openPdfForApplReciept

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