Passport Application Form
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CONSULATE GENERAL OF INDIA
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SAN FRANCISCO
540 Arguello Boulevard
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San Francisco, CA 94118
THIS FORM IS FOR ISSUE OF FRESH PASSPORT AFTER 10 YEARS (FINAL) & DUPLICATE PASSPORT
Tel: (415) 668-0662 Fax: (415) 668-9764
ALSO FOR ADDITIONAL PAGES / CHANGE OF NAME/APPEARANCE
(Mailing address as above)
APPLICATIONS ARE ACCEPTED AT THE COUNTER FROM 9:00AM TO 12:00 NOON (MON. TO FRI.). PERSONAL CHECKS/CREDIT CARDS ARE NOT ACCEPTED
INCOMPLETE APPLICATION WILL REMAIN UNPROCESSED
(PLEASE PRINT IN BLOCK LETTERS ONLY)
1. (a) FIRST NAME, MIDDLE NAME
(b) LAST NAME (surname or family name)
(c) MAIDEN NAME (for married woman)
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(d) HAVE YOU EVER CHANGED YOUR NAME?
Yes
No
If yes, please write your name in full: ___________________________
______________________________________________
2. PLACE OF BIRTH
3. COUNTRY OF BIRTH
4. DATE OF BIRTH
PASTE
______ / ______ / __________
PHOTO HERE
(DD)
(MM)
(YYYY)
Size: 3.5 X 3.5 cm
9. MARITAL STATUS
5. SEX
6. COLOR OF EYES
7. COLOR OF HAIR
8. HEIGHT
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MALE
FEMALE
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MARRIED
UNMARRIED
10. (a) PRESENT PASSPORT NO
(b) PLACE OF ISSUE
(c) DATE OF ISSUE
(d) DATE OF EXPIRY
____ / ____ / _______
____ / ____ / _______
______________________
____________________________
)
(DD)
(MM)
(YYYYY)
(DD)
(MM)
(YYYYY
COUNTRY OF HIS BIRTH
11. (a) FULL NAME OF FATHER
NATIONALITY
SIGNATURE OR
THUMB IMPRESSION
Left –Male / Right - female
(b) FULL NAME OF MOTHER
NATIONALITY
COUNTRY OF HER BIRTH
(within the box)
FOR OFFICIAL USE ONLY
(c) NATIONALITY OF FATHER AT THE TIME OF APPLICANTS BIRTH
(d) NATIONALITY OF MOTHER AT THE TIME OF APPLICANTS BIRTH
(c) CONTACT PH. NO.
12. (a) FULL NAME OF SPOUSE
(b) NATIONALITY
13. PROFESSION
14. BUSINESS/OFFICE ADDRESS
15. (a) PERMANENT ADDRESS IN INDIA
(b) TEL NO.
16. (a) ADDRESS IN USA
(attach a proof address e.g. State ID/Drivers License or utility bill)
_______________________________________________________________________________________________________________
FILE No:
(b) ALIEN REGISTRATION CARD/EMPLOYMENT CARD NUMBER (Attach a copy of status e.g.
green card, employment authorization card, I-94, Visa type: B, H, L & etc..)
_____________________________
17. CONTACT INFORMATION:
18.
HOW LONG HAS APPLICANT CONTINUOUSLY
(a) HOME : (
)
RESIDED ABROAD? (excluding short visits)
REF
ADC
CLR
(b) CELL : (
)
19.
WHEN WAS HE/SHE IN INDIA LAST?
(c) WORK : (
)
DE
PSS
PA
20.
WHEN DID APPLICANT FIRST LEAVE INDIA?
(d) EMAIL :
NEW PASSPORT NO:
21. PRESENT INDIAN IMMIGRATION STATUS
*ECR / **ECNR _________________________ (Attach documentary evidence e.g. educational qualification / diploma)
* Emigration Clearance Required
** Emigration Clearance Not Required
22. ARE YOU A CITIZEN OF INDIA BY?
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BIRTH
DESCENT
NATURALIZATION
REGISTRATION
YES
NO
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23. DID YOU EVER POSSESS ANY OTHER NATIONALITY OR TRAVEL DOCUMENT OF ANY OTHER COUNTRY?
If yes give details: _________________________________________________________________________________________________________________________
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24. WHERE YOU EVER REFUSED A PASSPORT?
If yes give details/attach copy of official communication letter: ___________________________________________________________________________________
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25. WAS YOUR PASSPORT EVER ORDERED TO BE IMPOUNDED OR REVOKED?
If yes give details/attach copy of official communication letter: ___________________________________________________________________________________
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26. ARE ANY CRIMINAL PROCEEDINGS PENDING AGAINST APPLICANT IN ANY COURT IN INDIA?
If yes give details: _________________________________________________________________________________________________________________________
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27. HAS APPLICANT EVER BEEN REPATRIATED FROM ABROAD TO INDIA AT THE EXPENSE OF GOVERNMENT OF INDIA?
I If yes give details: ________________________________________________________________________________________________________________________
28. MODE OF PAYMENT
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CASH
MONEY ORDER/ CASHIERS CHECK # __________________________________
AMOUNT US $ ______________
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