GOVERNMENT OF INDIA, MINISTRY OF
EXTERNAL AFFAIRS
PCC APPLICATION FORMS
Please read the
Passport Instruction Booklet carefully before filling the form. Fill this form
in CAPITAL LETTERS.
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. All fields marked
with (*) are mandatory to fill.
Passport Number
*--------------------------------------
Date of Issue
(DD/MM/YYYY) * ----------------------Date of Expiry (DD/MM/YYYY) *---------------------
Place of Issue *----------------------------------------------
Country for
which PCC is required *----------------------------
Applicant
Details
Applicant's
Given Name-------------------------------------------------------------------
(Given Name means First name followed by Middle name (if any))(Initials not
allowed) *
Surname
Date of Birth
(DD/MM/YYYY) *------------------------------------
Village or Town
or City *-------------------------------------------
Gender * ---------------------------------Marital
Status * ---------------------Citizenship of India by *
Employment Type
*-------------------------------
Educational
Qualification * -----------------------
Aadhaar Number---------------------------------------
Family Details ---------------------------------------------------------------------------------(You
have to provide atleast one Father/Mother/Legal Guardian details.) *
Father's Given
Name -----------------------------------------------------------------------(Given
Name means First name followed by Middle name (if any))(Initials not allowed)
Surname--------------------------------------------------------------------------------------------
Mother's Given
Name--------------------------------------------------------------------------
(Given Name means First name followed by Middle name (if any))(Initials not
allowed)
Surname-------------------------------------------------------------------------------------------------
Legal Guardian's
Given Name --------------------------------------------------------------------(Given
Name means First name followed by Middle name ------------------------------------
(if any))(Initials not allowed)
Surname-----------------------------------------------------------
Present
Residential Address Details
Residing Since *
Month Year-------------------------------------------------------
House No and
Street Name *------------------------------------------------------------
Village or Town or City
*--------------------------------------------------------------------
State/ UT *-----------------------------------------------------------------
District *---------------------------------------------------------------------------
Police Station *------------------------------------------------------------------
PIN * Mobile
Number * -------------------------------------------Telephone Number--------------------------
E-mail ID---------------------------------------
Is permanent
address same as present address? * -----------------Yes No---------------
References in
your Village or Town or City *------------------
First Reference
Name and Address *----------------------------------
Mobile Number
Telephone Number---------------------------------------
Second Reference
Name and Address *-----------------------------------
Mobile Number
Telephone Number----------------------------
Other Details
Any criminal
proceedings pending against you before any court in India? * ---------------------Yes
No----------
Self 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 the citizenship of India and I affirm that
the information given by me in this form and the enclosures is true and I
solely responsible for its accuracy, and I am liable to be penalized or prosecuted
if found otherwise. I am aware that under the Passport 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 agree
Place * ----------------
Date (DD/MM/YYYY) *---------------------------
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