Affix Photo here Consulate General Of India

San Francisco

Personal Particulars Proforma

(To be submitted (4 copies) by all applicants for issue of duplicate passport in lieu of lost passport)

1. Name : ___________________________________

2. Aliases, if any : ___________________________________

3. Name of Father/Husband : ___________________________________

4. Date and place of birth : Day _______ Month ________ Year ______ Place _________

5. Nationality : ___________________________________

6. Occupation : ___________________________________

7. Present address : ___________________________________

8. Permanent address in India : ___________________________________

9. Details of lost passport:

                        Number        : _____________________
                        Date of issue : _____________________
                        Place of issue: _____________________

10. Exact date of loss of passport : ___________________________________

11. Exact date of lodging loss report with the local police : ___________________________________

12. Exact date from which the applicant has been residing abroad : ___________________________________

Signature of Applicant : ___________________________________

Date : ___________

For official Use

13. Whether loss of passport circular has been found by the concerned PIA.