HIGH COMMISSION OF INDIA i NAIROBI APPLICATION FOR MISCELLANEOUS SERVICES Please affix passport a size photograph 2. | FullName 2. | Father's / Husband's name Eerie eee 3._| Date of Birth Place of birth | : 4._| Nationality 5._| Permanent Address in india, ifany: ‘Contact No 3 Present Address in Kenya: ‘Contact No : : 7._| Details of Current Passport: A Passport Number | : a Date of issue [= Place of Issue E Valid Until |= Detalls of OCI Card, any: ‘OCI Card Number Place of Issue 9,_| Services required : Please indicate (Tick) __ ‘a, | Attestation of documents (please specify the document) b_| Affidavit (please specify purpose): c._| Power of Attorney | : d._| Police Clearance Certificate (PCC) (please specify country): e._| Renunciation A z ¥._| Other Misc. Services: = Applicant/s please attach: copy of pasSport, copy of OCI, copy of work permit, one extra photograph * tn case of joint Affidavit/Power of Attorney, details of each applicant may be provided overleaf: Date of Issue Valid Until Date:__/_/2019 Place: Nairobi T.l/Signature of the applicant/s FOR OFFICE USE ONLY Fee receipt No: Fee Amount Name of Service/s_[ + No. of Services Date of delivery Remarks: Misc. Service Dated: 2] —/_)2039 No/s: i Signature of official fe