Loss Of Passport Form (Page 2 of 2) in pdf

Loss Of Passport Form Page 2

DETAILS TO BE FURNISHED ALONG WITH

APPLICATION FORM FOR DUPLICATE PASSPORT

1. Name : ___________________________________________________________________

2. Aliases, if any : ____________________________________________________________

3. Father’s / husband’s name : ___________________________________________________

4. Occupation :_______________________________________________________________

5. Present address

_______________________________________________________

(Address in Thailand):_______________________________________________________

6. Permanent address in _______________________________________________________

India :

_______________________________________________________

7. Details of the lost passport :-

Passport No. : _________________________________________________

Date of issue : _________________________________________________

Place of issue : ________________________________________________

8. Visible Identification Marks : _________________________________________________

9. Exact date of loss of Passport :________________________________________________

10. Exact date of lodging FIR :

_________________________________________________

(Report with local Police)

_________________________________________________

11. Exact date from which the

_________________________________________________

applicant has been residing

_________________________________________________

abroad :

_________________________________________________

__________________________

Date : __________________

( Signature of the Applicant )

Loss Of Passport Form Page 2