Annexure-‘F’

AFFIDAVIT FOR A PASSPORT IN LIEU OF LOST/DAMAGED PASSPORT

SWORN AFFIDAVIT

I, ……………………………………………………….……………………...………. holder of
Indian Passport No.___________________ issued at _______________________ on
_______________, presently residing in _____________________________________
_____________________________, do solemnly affirm as follows: That my above
mentioned passport is genuinely lost.

The passport was lost/damaged on ____________(date) in the following circumstances:

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Lost Document Report was lodged with Tamilnadu Police dated
____________________________, bearing number _________________________

That I have not lost or damaged any of my previous passports

That I have not travelled on the lost/damaged passport.

I have not availed of any Transfer of Residence concessions / FTs allowance

There had been no objection by the Passport Issuing Authority on my passport

I have not been deported at any time at the expense of Government of India.

I further affirm that I will take utmost care of my passport if issued and the Government
will be at liberty to take any legal action under the Passports Act, 1967, if the lapse is
repeated.

Date:
Place :
Tel. No. (Signature of Deponent)