POLARAID/INSTANT PHOTOS NOT ACCEPTABLE From Nol External Free of charge GOVERNMENT OF INDIA saree ftrgra [thea i acta ree & fore orate a APPLICATION FORM FOR INDIAN PASSPORT AT AN INDIAN MISSION/POST 35 FAR x a5 PL are otter ater Ie are aT (a /10 a4 (fam are eae ra er ae ae aa arent att eer ei ae gene Tao grand sath ae & Ferg) safeefartet etenrel af 21) (Gor the issue of an ordinary international passport sioos pste on recent sur Fresh/ After 10 yeas! (Fina, for duplicate passport Sse Asm protograph in lieu of lost/ damaged passport and for hore and enclose three more issue of emergency certificate) cant colar photographsipoarais ‘gency > photographs are not acceptable) (ores ee Ha oe Fava se arta & on rome Ha whe ant oer we ae Applicant must paste one photograph above with balf the signature on the photograph and talon the application eer a Specimen Signature (Aaya a, ge sa ae | ease Delete inapplicable ) eH I ra (Hae we HT FTV Payment of Free (to he filled by applicant) vgrara og aft Amount paid RM art by ______ pra ft faftr/ Mode of payment 1. (@) GUAT / Full Name (grea stearate wera a8) / (expanded initials) Surname (saa) (b) harm, afe aig 2/ Aliases, if any. (co) Far aires 4 ea afl ata aH aaaT eS Tae wi, ea a qT ATH aeTE- Has applicant ever changed his/her name If so, give previous name in full.2, FAT FAPH/Date of birth —__1 @74iPlace of bith (Country ‘ararg /Height —————(@ 4.) /(cms.) sti 1 #1/Colour of eyes ———————-_ 4/Hair Wear aI wae fare, afe ae 2. Visible distinguishing marks, if any 3. aft wan /Permanent Address (a) ARa#/In India (b) stftrarer & @ar H/ Address in Malaysia 4. @_— fear 1AM /Name of Father ——————— sa sien sr 2a1/Country of his Birth (i) FAT #1 ATH/Name of Mother ——————— 3% wea a 2a1/ Country of her birth- Gai) Tree Se eer fra St este Nationality of fa at the time of applicant's birth- anaes oem & ge re A TACT Nationality of mother at the time of applicant's bisth 5, Reafear/sftanfear Vari / Martied / Unmarried (Vick mark) 6. 9fa/sroft rae afte aeftrat/Name and Nationality of husband / wife 7. yey spear gate ah ae feat ee eae am fare Fare efera fara sree Particulars of person to be intimated in the event of death or accident ‘ae /Name. sa/Adaess 8, ade orerttd astiaar veerr-wa af at 2 A eq —— ote tt ot act a ea Present Passport(No,_ ate ofisoue Place of issue 9. partie an gefin area cee —————ait na ante ater Local car driving Licence No: ate and Place of issue 10, fre até Educational qualification (evar Soh & Pe Fe) fn order to detesmin emigration stats )mre 9 aa Tes HR Ba BIT aT] ———— ae afer arc ea ea aft] When did applicant first leave India? —_______ When was he/she in India last?) ——___ 12, arreeap Papert erry arrra: Faear wer a7. How long has applicant continuously resided abroad? 13, ada sora Soh (Soares ais sass @ sear SeaTaA Fra sae AEE 8) Present Emigration Status ( BCR or ECNR) (eet TEA BEA) (With documentary evidence ) 14, ai ram ait Gat Name and address of ——_______ fia. aa aH ax % Company where employed Telephone of Residence! Hand phone No: 15, arse ae a a se er 8 erg ato ata eer oe ae 7 Please mention if citizen of India by birth / descent / nationalisation / Registration. os, ar reas 3 rea Tea a A eve i eh ae Ret ro ae aT 7 AR, Ta aA Did application ever possess any other nationality or travel document of any other country? If so, please give details. 17. Far areas ah ea a rete arenes BS a fa aT 7 AR ai, Sea ah a Carey ‘Was applicant ever refused an Indian Passport ? (YesiNo) 18, Far ona a TE ves a sees fea aT ae fae TT ae, sears ZC ge) Was applicant's passport ever impounded! revoked? If so, details please (YesiNo } 19, a eter fet arate Name and address of two relatives) friends o @ ao. A ae aE a are 3 aes aGRA A arias Pear Ga HR 7 ae ei, at gersTad & ate a Reda arg aera sa da aE Is applicant in Govt, Service! Public Undertaking Service/ Statutory Bodies Service of India? If so, Please give details and enclose 'No objection Certificate’ from your employer in original21. (ger ake & ree at ft caer aA teh ee we OT #7 aE Gat GeTETOT sh ‘Are any criminal proceedings pending against applicant in any court in india? If so, Please give details. (i) Fa Tee gee anh an eR ad oe Gar welt Fae DARE ai, a UAT SAT wate Has applicant ever been repatriated from abroad to India atthe expenses of the Govt.of India? If so, details Please a, wy entesrent ay RTE AY GTS AR ART PAP aca ee TET YY ATE asta ‘erat ht staf. No. of lost’ damaged passport Place of issue Date of issue Valid until 23.) Par arr Tea & ye at A/G wa aA /aaftores af aA A oe ar aides & Ate sik aR a aria aa sre Hh feata # eartia afore at aot aed fea at aft cae | Briefly state circumstances of los / theft damage of passport on a plain paper and attach copy of report lodged with local police in case of loss / theft. (i reas 3 ear ty ore af NE we, see aA 1 Give dtals of restiton, if ny put on applicant's damaged! lost passport ay Fa ea eee Se TRAE aa aa, Ra aa ata era a oraT aT? aR, A arawaarata Did applicant aval transfer of residence, foreign travel scheme facility on lost! damaged passport? If so, details please. 24, Far areca recta fees Haga 2 7 fe ah, ot aa ae feet seta aires aT ese Is applicant rogistere with Indian Mission! Post? If not, is he a member of any Indian Organisation ? 25, fe fare ae ar aH BeareT ST 2 ATs fea Particulars of childven, if any, to be deleted a aa ear sik TS fam/Sex Name Place & Date of birth (ge (iF) Note: arf ou 3 ai at aren & sree a8 fg are amt, 18 a a oH al a Bas 5 ara aw A carn Par ref a | Separate passport will be issued to children of all ages. However, children below 18 years of age will be given a S.years maximum validity passport26. aa DECLARATION ae rea A aia, ha sik svete ia rar & ait Ha eae B fare ora Sar A aie steer ToT ETA Te TEE faa | Fa ara A antenna shea ta GS, aA aA faa fae Te owe allegiance to the sovereignty, unity and integrity of India and have not voluntarty acquired the citizenship or travel document of another country. I have not lost. surrendered or been deprived of citizenship of India, 2 ot ora dt 2 ae adi 2 aheselara % fa A qh ae a Rrtan G1 ye ee ara Al srt 2 PH cae /aTAT cee a rater a aA re Sa ITAA TTS sePTAA, (8G FH area aT | The information given by me is true and iam solely responsible for its accuracy. Tam aware that itis an affence under the passport Act, 1967 to furnish any false information or to suppress any material information with a view to obtaining passport or any other travel document, Place ante acne eS a Pre Date (Get a she AH a era SHB H Fe) Signature / Thumb Impression of applicant (Left Hand T1. if male and right Hand TLLif female ) op araferr yf ware afte her 3 areas 3 ake Hi Prefer sarrae & In case of minors, following passport particulars of both parents must be given rat/ Mother fe/Father (a) WHE. / Passport No (b) sre a4 Fr antral /Date of Issue (o) are 4 ar BaTA/ Place of Issue (A) fe vara Fae # areraté % fore area fara @, ai rea a, a3 fa 2 /1f parents have applied for a pasport, please give File No. & date28. fe qreratd aranferr & fara @ ait rar atte fer seer oaftrarass A Brew: (HTaT Va aT seraT sifnTa eeaTET a), Declaration of Patents or Guardian if passport is for minor :( To be signed by both Patents or Guardian ) ar gfe 8 # fs ora ath (a) A/oph fore aft ‘reset racic & iH @ see Ta oR A Feta ae re BE a Free sham apa & fs weet ah et ae a aE, eve aT aT Paar, oho A eT a hes at sa & SAK eH SHH A seh eat Hg arth aS 1 we At aa a @ fs La sara Fe aed 3 a EE ‘We affirm that the particulars given above are in respect of (Name } Son / daughter of Smt Sh. of whom we are the Parents / Guardian, We undertake the entire responsibility for his/her expenses. We solemnly declare that he/she has not lost, surrendered ot been deprived of his/her citizenship of India and that the informati respect of him/her in this application is true, It is also certified that the name of the child mentioned is not passport of either parent. given in included in AND. OR, are Mother fea Father: sifiraTes (Guardian sre ah Refi ecg Bene (pe Bs a eft eee oi a ere) Name & Signature) TI of both the Parents/Guardian(left hand Tf male and Right hand Tif female) BI) Place Seri / Date 29, ate fay fea cara F eee arma ais & Fara ar ET Specimen signature or T.I.within the Space given below