(For use in Indian Mission / Post)
(a) Renewal (b) Additional Booklet
(c) Change of Address (d) PCC
(e) Additional Endorsement (f) Child Inclusion/Deletion
(g) Additional Visa sheet (h) Emergency Certificate (i) Any Other Service (Specify)

__________________________________________________________________________________
 

(Please delete inapplicable)
 

                                            Applicant must paste
                                            ( 35 x 45 mm ) one
                                            photograph here with
                                            half the signature on
                                            the photograph and
                                            half on the application.

Payment of Fee (to be filled by applicant)

Amount Paid $/£_____________________________   by   _____________________________

(Mode of Payment) _______________________________________________________________
 

1. Full Name ___________________________________________________________________

2. Applicant's Car Driving Licence No. __________________________________________

   Date & Place of Issue________________________________

3. Residential address :

(i) In India                     (ii) In country of domicile
________________________________     ____________________________
________________________________     ____________________________
________________________________     ____________________________
________________________________     ____________________________

Tel ____________________________   Tel. _______________________
 

4. Profession and business address _______________________________________________________

   _______________________________________________________________________________________

  Tel. _____________________

5. Is applicant registered with the Indian Mission/Post ? If not is he a member of any Indian Organisation ? Give details.
 

6. (i) Name of Father ___________________________________________________________

(ii) Name of Mother __________________________________________________________

(iii) Name of Spouse & Nationality __________________________________________________________
 

7. Current Passport No. ____________________________

   Valid until __________________________

   Place of issue _____________________________

   Date of issue _____________________________
 

8. Particulars of children to be included/deleted :

Name                     Place & Date of Birth             Sex (M/F)

______________________ ________________________________ ____________
______________________ ________________________________ ____________
______________________ ________________________________ ____________
______________________ ________________________________ ____________
______________________ ________________________________ ____________
______________________ ________________________________ ____________
 

NOTE : In case a fresh inclusion of name(s) enclose
(i)  Birth certificate(s) bearing names of both parent's
(ii) Marriage certificate of parent's and
(iii)Passport of both parent's. Children below fifteen years of age can either apply for
     inclusion in their parent's generally mother's passport or
     apply for separate passports. Children above fifteen must apply for separate passports.
 

9. DECLARATION :

I solemnly affirm that

(i) I owe allegiance to the sovereignty and integrity of India.

(ii) Information given above is correct and nothing
has been concealed and I am aware that it is an offence under
the passport Act 1967 to knowingly furnish false information
or suppress material information ; and
(iii) I undertake to be entirely responsible for expenses of my
son/daughter/ward
 
 
 

______________________________________
Signature of applicant of T.I. of his
legal guardian ( Left hand thumb
impression of male and right hand
thumb impression of female)
 

Place __________________________ Date __________________________
 

10. Two specimen signatures or thumb impressions required
for service(s) within the space given below.
 
 

___________________________
| |
|_________________________|
 

___________________________
| |
|__________________________|

____________________________________________________________________

FOR OFFICE USE