Page 233 - STATE v ARIF & ORS. SC-NO-540-2022 PART 1
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                                                'llrol  'Q(Cfij(
                                         GOVERNMENT  OF  INDIA

                                                ~1(1  4siR"'4
                                   MINISTRY  OF  EXTERNAL  AFFAIRS

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           ~              :i!llf.l   PASSPORT  APPLICATION  FORM                                                   ..

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            (Please  Fill  In  BLOCK  LETTE~S)~GJIPOI~fe 20 Yaw
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            'l'RIPI  'Ill ..,.  ~ 3001·  ~  ~r. I
            1 "'OUnt  of  lee  paid  Rs.  3004  (__ b  O_'-
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            ~ W. 1i-....... 2.~J.7..&./.2L.:::z . .S...........   Bank Draft No .G.~.,S,~ .... ;;:.8.!n .. t.>S.I't.l..q.2 ............ ..

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                 (i) ~ Applicant ......... ~.u a.J... ........ a.l!f.~.tJ .. D ....... .k:.fi.w.tL ................. : ..................................... ..
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                (IQ ftar 1 Father . .IA/.£. ....... .£U • .I ......... .H.¥:1f.it;.ltGr-;,;;a ...... IW!."'.A... .. ~~-.. ---.: ... ~ ................................. .
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                (iii) '111111/ Mother .......... .e.tt.r::.l..tr.?./1.:: .... ~: ....... ,.-,:.: ..................................................................................... .
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                (iv) 'lftlt'liilt 1 Spouse ...... -":l'l.. .. ~~-~ ............................................. ; ................................................. ..
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            3.  01'11  tidil t Date  of  Birth            ..._  .,         ~

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            .;,  iiPIJ 1'1F1 J PJBCB of  Birttl,,,,,,, .. ,,,,,,,J:::1,,,,.,,,,,,, , _,l,?\,J,~~~•:.\ouo:, ..... ,,,, .... ,.,,,,,,,,,u••••••••••nooooo•u•••••••••••••"••••u••••
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         ...-.:1) 'IRil il M  'lilT/Permanent Address  in India:
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              lliF. -;r)!;· 1 House Nama/No ..... -?.:.~/k..........  .._  '11m 'l;f '!1"' t'i•l House NarnatNo ..... ~./.4 .............. ,:.
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              111"1t"R''lt·  ln./Street .... s:-.lf.N."J':-/I'·A........................   Ttlif/mfl/ VIII.ISirEIGI ...... 5K..I:f.Y..fl:. .......................... .
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              -1 Post Office ........ S..1 .. R .. · .. 6'..et.:n.j. ..... ::.:; ..... ..   'll'fliR/ Post Office ..... .S:.s.E .. ~ .. 4Bmd'"','"'"'"'''""'"'"
              ;me 'IFill Police Station ... S.: .. S .. .,. .. ~fif:!'.t ..... ..   ~ fiFIIIPollce Stallon .S. .. ~-~ .. :.41~..-1 ............. .' .. ..
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              ~/Disii ..... $-.D../..1>1./J.C.~---···--·--"'''""'''""   _,, Distt ........ :;7-.'6.:1...~ ............................ .
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              VIlli State .J4.1na:m.M .... ~ ~.l!.:m,r:Y.: ......   ~ State ...... J.tliM'I.-:Y.l1.1'l .... z,! .... K.IMi .... :nt:tt1;zL.,·.
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              flr.PRIIPIN  Code                               \1A  m1 °1N Code
           ·I  ~wl1'91 No ........ 4.'!7.~a . .s&. .................. ..   ~~!Tel. No .... ~,;J~:-tJ5..:P. ..
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