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Passport Number

Date of Issue(DD-MM-YYYY)

Date of Expiry(DD-MM-YYYY)

Place Of Issue

Country for which PCC is required

Purpose for which PCC is required

If others, then state the purpose clearly

Applicant Details

Applicant's First Name

Middle Name

Surname

Gender

Place Of Birth

Date of Birth

Birth Village or Town or City

Citizenship of India by

Marital Status

Employment Type

Educational Qualification

Pan (If available)

Voter ID (If available)

Aadhar No

I, the holder of above mentioned Aadhaar Number , hereby give my consent to Passport Seva to obtain my Aadhaar Number, Name and Fingerprint/Iris for authentication with UIDAI. I have no objection using my identity and biometric information for validation with Aadhaar (CIDR) database only for the purpose of authentication.

Family Details (Father/Mother/Legal Guardian details; at least one is mandatory.)

Father's First Name

Middle Name

Surname

Mother's First Name

Middle Name

Surname

Legal Guardian's First Name

Middle Name

Surname

Spouse's First Name

Middle Name

Surname

If applicant is Minor, provide following details

Father Passport Number

Father File Number

Father Nationality,if not Indian

Mother Passport Number

Mother File Number

Mother Nationality,if not Indian

Legal Guardian Passport Number

Legal Guardian File Number

Legal Guardian Nationality,if not Indian

Present Residential Address Details (where applicant presently resides)

House No. and Street Name

Village or Town or City

Country

State/ Province

District

Nearest Police Station

Mobile No

E-mail ID

Do you have a Permanent Address?

Is permanent address same as present address?

House No. and Street Name

Village or Town or City

Country

State/ Province

District

Police Station

Other Details

1) Provide the following details if there are any criminal proceedings pending against the applicant.

Are any proceedings in respect of an offence alleged to have been committed by you pending before a criminal court in India? *

Has any warrant or summons for your appearance been issued and pending before a court under any law for the time being in force? *

Has a warrant for your arrest been issued by a court under any law for the time being in force? *

Has an order prohibiting your departure from India been made by any court? *

Name of the Country

2) Provide the following details if the applicants has been convicted by a court in India.

Have you, at any time during the period of 5 years immediately preceding the date of this application, been convicted by a court in India for any offence involving moral turpitude and sentenced in respect thereof to imprisonment for not less than two years?*

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.

I Agree

Place

Date (DD/MM/YYYY)*

₹

Note:
Applicants are required to submit the proof of address of the present address only, irrespective of the date from which he/she has been residing at the given address.