01/12/2013

Application Form

Passport Application
Government of India, Ministry of External Affairs
Online Application Receipt
Applicant Details :
Application Reference No 13-1010737833
Service Type
FRESH
Type of Application
Normal
Application Submitted Date01/12/2013
Date of Birth
13/06/1988
Gender
MALE
Employment Type
PRIVATE
Marital Status
SINGLE
Place of Birth
GANGAVATHI,KOPPAL,KARNATAKA
Given Name
SANDEEP
Surname
RAJPUROHIT
Father's Name
PANDURANGACHAR RAJPUROHIT
Mother's Name
TUNGABAI RAJPUROHIT
Present Address
300, 4TH CRS, VIDHYAMANYA NAGAR,ANDRALLI, VISHWANEEDAM, BANGALORE - 560091,
KARNATAKA, INDIA
Applicants References :
First Reference Details
SANTOSH, 300, 4TH CROSS, VIDHYAMANYA NAGAR, VISHWANEEDAM(PO), BANGALORE-91,
9738540995, 08023245374
Second Reference Details MANOHAR DESHPANDE, 41/2, AYODHYA COLONY, SHRIRAMNAGAR, GANGAVATHI(TQ),
KOPPALA(DIST)-583282, 9449159645, 08533277014
Payment Details:#
Payment Status
Appointment Details :
PSK Location
Date & Time of
Appointment
Appointment Id
Reporting Time

Not paid

Thanks for showing your interest in 'Passport Seva SMS Services' enrolment. Please pay Rs 30/- (THIRTY ONLY) in cash as the
Enrolment Charges during your visit to Passport Seva Kendra.
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.
Applicant should bring all the originals and one set of photo copy, photo copies should be self attested by the applicant. In
case of m inor either of the parents has to sign on all photo copies.
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 recent coloured passport size (4.5 x 3.5 cm ) photograph w ith a w hite
background w hile visiting Passport Seva Kendra. Other applicants need not carry any photograph as photograph w ill be
captured at the Passport Seva Kendra.
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 such as cam era is prohibited inside the PSK.

# Details as per the Payment Date. Payment once made for availing passport services will not be refunded.

https://portal2.passportindia.gov.in/AppOnlineProject/secure/openPdfForApplReciept

1/1