File Number (For Office Use Only)
Service Required
Application Reference Number 14-1002921163
Applying For REISSUE
If Reis...
Spouse's Name POONKODI
Present Address Details
Residing Since(MM/YYYY) 08/2000
Address
16A THENDRAL NAGAR, VEERAKERALAM, C...
Self Declaration
I owe allegiance to the sovereignty, unity and integrity of India, and have not voluntarily acquired citi...
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Portal2.passportindia.gov.in app onlineproject_secure_vi

Published on: Mar 4, 2016
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Transcripts - Portal2.passportindia.gov.in app onlineproject_secure_vi

  • 1. File Number (For Office Use Only) Service Required Application Reference Number 14-1002921163 Applying For REISSUE If Reissue, specify reason(s) VALIDITY EXPIRED MORE THAN 3 YEARS AGO Type of Application TATKAAL Type of Passport Booklet JUMBO Validity Required NA Applicant Details Applicant's Name ANGUVADIVEL RATHINAM Date of Birth (DD/MM/YYYY) 20/02/1979 Place of Birth (Village/Town/City) KANNARPALAYAM District COIMBATORE RURAL State/UT TAMIL NADU Country INDIA Gender MALE Marital Status MARRIED Citizenship of India by BIRTH Employment Type PRIVATE Is either of your parent (in case of minor)/spouse, a government servant? N Educational Qualification 10TH PASS AND ABOVE Are you eligible for Non-ECR category? N Visible Distinguishing Mark MOLE BELOW THE RIGHT EYE Aadhaar Number 481147811660 GOVERNMENT OF INDIA, MINISTRY OF EXTERNAL AFFAIRS PASSPORT APPLICATION FORM Please read the Passport Instruction Booklet carefully before filling the form. Fill this form in CAPITAL LETTERS using blue/black ink ball point pen only. Furnishing of incorrect information/ suppression of information would lead to rejection of the application and would attract penal provisions as prescribed under the Passports Act, 1967. Please produce your original documents at the time of submission of the form.          Signature/Left Hand Thumb Impression of Illiterate Applicant and Minors who cannot sign.       Family Details Father's Name RATHINAM Mother's Name MARAGATAM Page 1 of 3View/Print Submitted Form 4/8/2014https://portal2.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=14-100...Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  • 2. Spouse's Name POONKODI Present Address Details Residing Since(MM/YYYY) 08/2000 Address 16A THENDRAL NAGAR, VEERAKERALAM, COIMBATORE, VADAVALLI, COIMBATORE, TAMIL NADU PIN 641007 Mobile/Tel No 9788823525 E-mail VSAI26.12.09@GMAIL.COM First Reference Name And Address A.GANESAN,S/O R.ARUSWAMY,14/28 LAKSHMI KOIL STREET,POOCHIYUR,NARASIMMANAICKEN PALAYAM,COIMBATORE 6410341 Mobile/Tel No 9578888455 Second Reference Name And Address G.JAYAKUMAR,S/O GANESAN,91/8 SIVATHANGAM NAGAR,SAKTHI ROAD, KURUMBAPALAYAM,COIMBATORE 641107 Mobile/Tel No 9943119002 Permanent Address Address 16A THENDRAL NAGAR, VEERAKERALAM, COIMBATORE, VADAVALLI, COIMBATORE, TAMIL NADU PIN 641007 Mobile/Tel No 9788823525 Emergency Contact Details Name and Address RATHINAM 16A THENDRAL NAGAR VEERAKERALAM COIMBATORE Mobile/Tel No 8012960160 Previous Passport/ Application Details Details of latest held/existing/lost/damaged Ordinary Passport Passport Number A5171222 Date of Issue 23/03/1998 Date of Expiry 22/03/2008 Place of Issue CHENNAI Payment Details Mode Of Payment Online/Internet Banking Date 08/04/2014 Receipt/Reference No IGS9139594 Amount Received (Rs.) 2000.00  (TWO THOUSAND ONLY) Enclosures 1. 6. 2. 7. 3. 8. 4. 9. 5. 10. Page 2 of 3View/Print Submitted Form 4/8/2014https://portal2.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=14-100...Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  • 3. Self Declaration 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 COIMBATORE Date 03/04/2014 Signature/Left Hand Thumb Impression of Applicant (If applicant is minor, either parent to sign) Print Close Page 3 of 3View/Print Submitted Form 4/8/2014https://portal2.passportindia.gov.in/AppOnlineProject/secure/ViewDraftAction?arn=14-100...Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)

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