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Indian Passport Index Card

Please affix
one
passport size
photograph here

PLEASE PRINT
Mr.
Mrs.
Miss
Surname		 First Name Middle Name


Father's Name		 Mother's Name


Spouse's Name


Place of birth   (city)		 (state or province) Date of birth (dd/mm/yy)


Address in India		 street city state or province


Address in U S A  street		 city state phone no.


Alien Registration Card (Green Card), Employment Authorization Card No.


Passport No.		 dated expiring on issued at


Profession / Occupation		 Visible Distinguishing Marks if any


For Office Only



Passport No.  		 Date of Issue Date of Expiry


CNY No.		 Date of Renewal Date of Expiry


Renewal No.