12/09/14 2:39 pm Application Form Page 1 of 1 https://portal2.passportindia.gov.in/AppOnlineProject/secure/openPdfForApplReciept Passport Application Government of India, Ministry of External Affairs Online Application Receipt ATM facility available at PSK for all Bank Cards Applicant Details: Application Reference No. 14-1007734091 Batch 23 Sequence No. 19 Reporting Time 03:30 PM Service Type REISSUE Type of Application Normal Application Submitted Date 12/09/2014 Date of Birth 27/05/1985 Gender MALE Employment Type STUDENT Marital Status SINGLE Place of Birth KARNAL,KARNAL,HARYANA Given Name MANUJ Surname KHURANA Father's Name SUBHASH KHURANA Mother's Name VEENA KHURANA Present Address HOSTEL H-102, IIM BANGALORE, BILEKAHALLI, BANGALORE, BANGALORE, 560076, KARNATAKA, INDIA Applicants References: First Reference Details ANKUR BHARTIYA, HOSTEL H-101, IIM BANGALORE, BILEKAHALLI, 8884532000 Second Reference Details SURAJ KUMAR BHAGAT, HOSTEL H-103, IIM BANGALORE, BILEKAHALLI, 9739482970 Previous Passport Details Old Passport No. F2586954 Passport Issue Date 18/03/2005 Passport Expiry Date 17/03/2015 Place of Issue CHANDIGARH Payment Details: # Total Fee (Rs.) 1500.00 Paid Fee (Rs.) 1500.00 Date and Time 12/09/2014 02:32 PM Transaction Id CP09810645 Appointment Details: PSK Location Bangalore, Sai Arcade, SAI ARCADE, SURVEY NO. 56/P, DEVARABISANAHALLI, MARATHAHALLI OUTER RING ROAD (OPP TO INTEL), BANGALORE Date and Time of Appointment17/10/2014 & 03:45 PM Appointment Id 100005787427214 Reporting Time 03:30 PM 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 time mentioned above for pre-checking of documents 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. One accompanying person from the family will be allowed along with Senior Citizens, Physically Challenged, Illiterate and Minor applicants only. Applicant will not be issued token at Passport Seva Kendra, if they report after scheduled appointment time. Minor applicants below 4 years of age need to carry a recent coloured passport size (4.5 x 3.5 cm) photograph with a white background while visiting Passport Seva Kendra. Other applicants need not carry any photograph as photograph will be captured at the Passport Seva Kendra. Carrying of corrosive substances or explosives, arms or any sharp objects which may cause physical harm or violence are prohibited inside the PSK. Electronic item such as camera is prohibited inside the PSK. # Details as per the Payment Date. Payment once made for availing passport services will not be refunded.

Application Form

Download PDF Report

Upload
manuj-khurana
View
5
Download
0

Embed Size (px)

Citation preview

12/09/14 2:39 pmApplication Form

Page 1 of 1https://portal2.passportindia.gov.in/AppOnlineProject/secure/openPdfForApplReciept

Passport ApplicationGovernment of India, Ministry of External AffairsOnline Application Receipt

ATM facility available at PSK for all Bank Cards

Applicant Details:Application Reference No. 14-1007734091

Batch 23Sequence No. 19Reporting Time 03:30 PM

Service Type REISSUEType of Application NormalApplication Submitted Date 12/09/2014Date of Birth 27/05/1985Gender MALEEmployment Type STUDENTMarital Status SINGLEPlace of Birth KARNAL,KARNAL,HARYANAGiven Name MANUJSurname KHURANAFather's Name SUBHASH KHURANAMother's Name VEENA KHURANAPresent Address HOSTEL H-102, IIM BANGALORE, BILEKAHALLI, BANGALORE, BANGALORE, 560076,

KARNATAKA, INDIAApplicants References:First Reference Details ANKUR BHARTIYA, HOSTEL H-101, IIM BANGALORE, BILEKAHALLI, 8884532000Second Reference Details SURAJ KUMAR BHAGAT, HOSTEL H-103, IIM BANGALORE, BILEKAHALLI, 9739482970 Previous Passport DetailsOld Passport No. F2586954Passport Issue Date 18/03/2005Passport Expiry Date 17/03/2015Place of Issue CHANDIGARHPayment Details:#Total Fee (Rs.) 1500.00Paid Fee (Rs.) 1500.00Date and Time 12/09/2014 02:32 PMTransaction Id CP09810645 Appointment Details:

PSK Location

Bangalore, Sai Arcade, SAI ARCADE, SURVEY NO. 56/P,DEVARABISANAHALLI, MARATHAHALLIOUTER RING ROAD (OPP TO INTEL),BANGALORE

Date and Time of Appointment17/10/2014 & 03:45 PMAppointment Id 100005787427214Reporting Time 03:30 PM Thanks for showing your interest in 'Passport Seva SMS Services' enrolment. Please pay Rs 30/- (THIRTY ONLY) in cash as theEnrolment Charges during your visit to Passport Seva Kendra. Note:

Applicant should reach the Passport Seva Kendra by the reporting time mentioned above for pre-checking of documents to avoidany 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.One accompanying person from the family will be allowed along with Senior Citizens, Physically Challenged, Illiterate and Minorapplicants only.Applicant will not be issued token at Passport Seva Kendra, if they report after scheduled appointment time.Minor applicants below 4 years of age need to carry a recent coloured passport size (4.5 x 3.5 cm) photograph with a whitebackground while visiting Passport Seva Kendra. Other applicants need not carry any photograph as photograph will be capturedat the Passport Seva Kendra.Carrying of corrosive substances or explosives, arms or any sharp objects which may cause physical harm or violence areprohibited inside the PSK. Electronic item such as camera is prohibited inside the PSK.

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