Personal Particulars Form

FORM - 21 Consulate General of India, Jeddah (Saudi Arabia) PERSONAL PARTICULARS FORM Paste your cross- (In Triplicate) signed recent colour [In case of Adverse/Incomplete Police Report] photograph. Size 3.5 x 3.5 cm 1. Full name (Initials not allowed) ………………………………………..………………………… ………. ……………………………………………………………………………………………………………… 2. Sex: Male / Female / Others ………………………………. (a) Has the applicant ever changed name? Yes / No (b) If yes, previous name: ………………………………………………………………………………..

4. Date of Birth: …/…/……. (dd/mm/yyyy) 5. Place of Birth …………………………………… 6. Profession ………………………………………………………………………………………………….. 7. a) Father ………………………………………………………………………………………………….. (Surname) (Name) b) Mother………………………………………………………………………………………………….. (Surname) (Name) c) Husband / wife ………………………………………………………………………………………. . (Surname) (Name) OLD (as in Passport) NEW/PRESENT (if any change in 8a) 8 a) Permanent Address & Tel. No. 8(b) Present Residential Address & Tel. No, along with along with Police Station (in India) Police Station and residing since (in India) Locality/Street : ...... Locality/Street ...... Village/Town : ...... Village/Town ...... Post Office : ...... Post Office ...... Police Station : ...... Police Station ...... Tehsil/Taluqa : ...... Tehsil/Taluqa ...... District : ...... District ...... State : ...... State ...... PIN : ...... PIN ...... Telephone/Mobile: Telephone/Mobile: 9. Address and Telephone Number/Mobile No. in Saudi Arabia and duration of stay: Address and Contact Mobile/Tel. No.:

Staying in Saudi Arabia since:

10. References: Names and Addresses of two responsible persons in the applicant’s locality who can vouch for the applicant. (IN INDIA ) (1) Name, Address & Tel. No. (2) Name, Address & Tel. No. ……………………………………… ………. …………………………………………………… ……………………………………… ………. …………………………………………………… ……………………………………… ………. ……………………………………………………

11. Citizenship of India by: (Please tick in the appropriate column) Birth Descent Registration Naturalization

12. Furnish details of previous passport / travel document, if any: (i) Passport No: ………………… (ii) Date & Place of issue …………………. (Previous Passport)

(ii) Passport No: ………………… (ii) Date & Place of issue …………………. (Present Passport)

For Police Use Only Signature or Thumb Impression of the applicant (Left Hand T.I. if male and Right Hand T.I. if female) Recommended Passport: YES/NO