Damaged Passport Form

Please confirm name as per current passport
Applicant Given name*
Surname
Hidden
Gender*
- Male
- Female
- Transgender
Have you ever changed your name?*
- Yes
- No
Previous Given name*
Previous Surname*
Applicant's Email id*
Applicant's Mobile Number*
Indian Contact Number*
Copy of utility bill*
Max. file size: 20 MB.
For address change
Date Of Birth (DD/MM/YYYY)*
DD slash MM slash YYYY
Place of Birth (Village/Town/City)*
Surname (To be changed)*
Is your Place of Birth out of India?
- Yes
- No
Region/Country*
State/UT*
District*
Marital status*
Employment type*
Educational Qualification*
Is either of your parent (in case of minor)/spouse, a government servant?*
- Yes
- No
Visible mark*
Adhaar number (If any)
Length of residence abroad/out of India*
Hidden
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How and When passport got damaged?*
Have you travelled on damaged passport? (if yes)*
- Yes
- No
Hidden
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Flight Number*
Date of Travel*
DD slash MM slash YYYY
Travel to (city)*
Hidden
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Number of Passport Damaged Earlier*
Hidden
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How and when passport was lost*
FIR lodges on date*
MM slash DD slash YYYY
FIR lodged at police station*
Number of Passport lost earlier*
Number of Passport Pages bearing departure and arrival stamps
Father Name as per passport
Given name*
Surname
Mother Name as per passport
Given name*
Surname
Spouse Name as per passport
Spouse's Given name*
Spouse's Surname
Hidden
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Police station (in India)*
Local Address (Australia)*
Street Address Address Line 2
Emergency contact
Contact name*
Address*
Street Address Address Line 2 District State / Province / Region ZIP / Postal Code Country
Mobile Number*
Have you ever returned to India on Emergency Certificate (EC) or were ever deported or repatriated?*
- Yes
- No
References in India other than Family Members
1. Reference person Details (in India)
Contact name*
Address*
Street Address Address Line 2 District State / Province / Region ZIP / Postal Code Country
Mobile Number*
2. Reference person Details (in India)
Contact name*
Address*
Street Address Address Line 2 District State / Province / Region ZIP / Postal Code Country
Mobile Number*

Save and Continue Later

Copy of Indian passport (Applicant passport) Front & Back page :*
Note : Please upload following images or send at [email protected]
Drop files here or

Max. file size: 100 MB, Max. files: 2.
Copy of FIR*
Drop files here or

Max. file size: 20 MB, Max. files: 1.
Please upload following images or send at [email protected]
Copy of Spouse Indian passport (First & last page)*
Drop files here or

Max. file size: 100 MB, Max. files: 2.
Hidden
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Copy of both parent passport (First & last page)*
Drop files here or

Max. file size: 100 MB, Max. files: 2.
Birth Certificate Copy Instead of applicant passport*
Drop files here or

Max. file size: 100 MB, Max. files: 2.
Mother's Signature*
Drop files here or

Max. file size: 100 MB, Max. files: 1.
Father's Signature*
Drop files here or

Max. file size: 100 MB, Max. files: 1.
Child's Photo*
Drop files here or

Max. file size: 100 MB, Max. files: 1.
Parent's Marriage Certificate*
Drop files here or

Max. file size: 100 MB, Max. files: 1.
Father's Occupation*
Mother's Occupation*
Consent*
I agree to the privacy policy. For any repreparation because of your inputs change there will be an extra fee of 10$* per application.

Save and Continue Later

Phone:	Tol Free: 1800 957 157
	Land Line: 03 9088 0486
Email:	[email protected]

New Passport - fix

Please confirm name as per current passport

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Father Name as per passport

Mother Name as per passport

Spouse Name as per passport

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Emergency contact

References in India other than Family Members

1. Reference person Details (in India)

2. Reference person Details (in India)

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Consular Mitra

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