APPLICATION
FORM FOR INDIAN PASSPORT AT AN INDIAN MISSION / POST
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(FOR ISSUE OF AN ORDINARY
INTERNATIONAL PASSPORT
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Applicant must paste one Photograph above with half the signature on the photograph and half on the application. |
(Please
Delete inapplicable)
Payment
of Fee (to be filled by applicant)
Amount
paid $___________ by _________________ Mode of payment
For
delivery by mail $ /£/ Extra
to be paid as postal charges for each passport
_________________________________________________________________________________________
_________________________________________________________________________________________
1.
(A)
Full Name_________________________________ surname __________________________________
(B) Aliases, if any __________________________________________________
(C)
Has applicant ever changed his/her name? _________________________________
If
so, give previous name in full __________________________________________________________
(D)
Maiden name, if applicant is a married woman_________________________________
2.
Date of birth (dd/mm/yy)_____________
Place of birth ___________________ Country __________
Sex_____
Height________(cms) Color
of eyes ____________ Hair
______________
Visible
identification marks, if any __________________________________________________________
3.
Permanent Address
(a)
In India __________________________________________________________
(b)
In Country of domicile __________________________________________________________
4.
(i) Name of father __________________________ Country of his birth _____________
(ii)
Name of mother_________________________ Country of her birth _____________________________
(iii)
Nationality of father at the time of applicant’s birth _________________________
(iv)
Nationality of mother at the time of applicant’s birth ________________________
5.
Married / Unmarried (Circle one)
6.
Name & Nationality of Spouse _________________________________________
7.
(i) Name of applicant’s eldest son or daughter (first child) _______________________
(ii)
Name of applicant’s eldest brother or sister ________________________________
8.
Present Passport number /National identity card, if any No.___________ Date
and Place of issue ___________
9.Local
car driving Licence No.._______________
10.
Educational Qualification ____________________________________________
(in
order to determine emigration status)
11.
When did the applicant first leave India? ______________ When was he/she in
India last? _________
12.
How long has applicant continuously resided abroad? _____________________________________________
13.
Present Emigration Status (Emigration Clearance Required/Not Required) ___________
14.
Profession and business address ___________________________________
Telephone : _______________
15.
Please mention, if citizen of India by birth/descent/naturalization/registration
___________
16.
Did applicant ever possess any other nationality or travel document of any
other country?
If
so, please give details _________________________________________________________________
17.
Was the applicant ever refused an Indian passport Yes / No
(Circle
One)
18.
Was applicant’s passport ever impounded/revoked? If so, details please Yes / No (Circle
One)
19.
Name and address of two relatives/friends
(i)
____________________________________________________________
(ii)
____________________________________________________________
20.
Is applicant in Government 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.
(i) Are any criminal proceedings pending against applicant in any court in
India? ____________
If
so, please give details _________________________________________
(ii)
Has applicant ever been repatriated from abroad to India at the expenses of
the Govt. of India?
If
so, details please
22.
No. of lost/damaged passport ___________________________ Place of issue _____________
Date
of issue _____________________________ Valid
until _________________
23.
(i) Briefly state circumstances of loss/theft/damage of passport on a plain
paper and attach copy of
with local
police in case of loss / theft .
(ii)
Details of restriction, if any, put on applicant’s damaged/lost passport ________________________________
(iii)Did
applicant avail transfer of residence, foreign travel scheme facility on lost/damaged
passport?
If
so, details please _____________________________________
24.
Is applicant registered with Indian Mission/Post? If not, is he a member of
any Indian Organization?
______________________________________________________________________________________
25.
Particulars of children, if any, to be deleted.
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Name
|
Place
& Date of birth
|
Sex
(M/F)
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| ___________________ |
___________________ |
___________________ |
| ___________________ |
___________________ |
___________________ |
| ___________________ |
___________________ |
___________________ |
| ___________________ |
___________________ |
___________________ |
| ___________________ |
___________________ |
___________________ |
below fifteen years of age can either apply for inclusion in their parent's
passport , generally mother's of apply separate
passport . Children above fifteen years must apply for separate passport.
26.
DECLARATION
I (To
be filled up by all applicants)
I
solemnly affirm that
(i)
I owe allegiance to the sovereignty and integrity of India; and
(ii)
information given above in respect of myself, my son/daughter/ward is correct
and nothing has been
concealed
and I am aware that it is an offense under the Passport Act of 1967 to knowingly
furnish
false
information or suppress material information, which attract penal and other
punishments under
the
Act; and
(iii) I
undertake to be entirely responsible for expenses of my son/daughter/ward.
___________________________________
Signature
of applicant or T.I. or his legal guardian
(Left
hand T.I. of male and right hand T.I. of female)
Place
: _________________________
Date
: _________________________
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FOR OFFICE USE