Passport ApplicationGovernment of India, Ministry of External AffairsOnline Application Receipt

ATM facility available in PSKfor all Bank Cards

Applicant Details :Application Reference No 14-0000140972

Batch 15Sequence No. 9Reporting Time 12:45 PM

Service Type FRESHType of Application NormalApplication Submitted Date04/01/2014Date of Birth 10/04/1996Gender MALEEmployment Type STUDENTMarital Status SINGLEPlace of Birth LUCKNOW,LUCKNOW,UTTAR

PRADESHGiven Name SHOBHITSurname GAUTAMFather's Name AJAY GAUTAMMother's Name LATE RITA GAUTAMPresent Address C-671, INDRA NAGAR, LUCKNOW, LUCKNOW, LUCKNOW - 226016, UTTAR PRADESH, INDIAApplicants References :First Reference Details SATYAVIR, EXECUTIVE ENGINEER, MAINTANCE DIVISION-1(CIVIL), UPPWD, MGROAD, LUCKNOW-

226001, 9452194099Second Reference Details SHILNDRA KUMAR YADAV, EXECUTIVE ENGINEER, COMMONICATION DIVISION-2, UPPWD, 96 MG

ROAD, HAZARATGANJ, LUCKN, 9956499319Payment Details:#Total Fee (Rs.) 1000.00Paid Fee (Rs.) 1000.00Date and Time 28/01/2014 04:43 PMTransaction Id CP04311059Appointment Details :

PSK LocationLucknow,RATAN SQUARE, 20-A, VIDHAN SABHAMARG, LUCKNOW-226001

Date & Time ofAppointment 10/03/2014 & 01:00 PM

Appointment Id 100004728959714Reporting Time 12:45 PM

Thanks for showing your interest in 'Passport Seva SMS Services' enrolment. Please pay Rs 30/- (THIRTY ONLY) in cash as theEnrolment Charges during your visit to Passport Seva Kendra.

Note:Applicant should reach the Passport Seva Kendra by the reporting time mentioned above for pre-checking of documents toavoid any hassles in issuance of token.Applicant should bring all the originals and one set of photo copy, photo copies should be self attested by the applicant. In caseof minor either of the parents has to sign on all photo copies.One accompanying person from the family will be allowed along with Senior Citizens, Physically Challenged, Illiterate and Minorapplicants only.Applicant will not be issued token at Passport Seva Kendra, if they report after scheduled appointment time.Minor applicants below 4 years of age need to carry a recent coloured passport size (4.5 x 3.5 cm) photograph with a whitebackground while visiting Passport Seva Kendra. Other applicants need not carry any photograph as photograph will becaptured at the Passport Seva Kendra.Carrying of corrosive substances or explosives, arms or any sharp objects which may cause physical harm or violence areprohibited inside the PSK. Electronic item such as camera is prohibited inside the PSK.Balance fee (if applicable) after editing the submitted form will be payable in cash at the Passport Seva Kendra.

# Details as per the Payment Date. Payment once made for availing passport services will not be refunded.