SECTION I - GENERAL INFORMATION
1. DELIVERY OF PASSPORTS:
Passport shall be delivered only to the applicant or dispatched by registered post acknowledgement due or speed post to the address given in the application form.
SECTION II - INSTRUCTIONS AND GUIDELINES FOR FILLING UP THE APPLICATION FORM
The Passport Application Form is Machine Readable. It will be scanned on computer. Therefore, the following instructions may be followed strictly:
Use capital letters only. Particulars given in the form will be printed in the passport. Therefore, please be careful in filling up the form and avoid any mistakes.	Write clearly within the box without touching the boundaries.
Use black/blue ball pen only.	Adjust the information to fit within the number of given boxes.
Do not fill the form with pencils or ink-pen.	Do not write anything outside the box. Avoid overwriting.
While filling up the boxes, kindly leave one box blank after each completed word.	Incomplete application will not be accepted.
Important Note: After filling up the Application Form, two clear photocopies may be made and photograph should be affixed and signatures and thumb impression appended in the given boxes in original. Thus, the set of Application Form in triplicate (one original and two photocopies) has to be submitted. With these original and photocopied Application Forms, attested copies of all required documents need to be attached. Illeterate applicants should put only thumb impression in both the boxes meant for thumb impression and signature as well. Incase an applicant has stayed at more than one address during the last one year, he/she should furnish two additional photocopies of the form for each additional place of stay. If the applicant has stayed at one place throughout the year, the number of copies of filled application required is one + two as explained above. But if the applicant has, for example, stayed at three places during the last one year, he should submit seven i.e. one original plus six copies of filled in forms altogether. Sign and thumb impression on each copy of the form. Please remember that all copies require signatures and thumb impression in original. Paste (do not staple) two photographs on each form, in the space provided.
SECTION III - COLUMN-WISE GUIDELINES FOR FILLING UP THE APPLICATION FORM
At the beginning of the Application Form there are boxes for affixing photograph, appending signature and thumb impression and giving details of payment of the fee.
PHOTOGRAPHS: Recent passport size photographs (four) in colour showing frontal view of full face against a dark background are required. Black and white photograph, photograph with coloured or dark glasses or in uniform, Polaroid prints or computer prints will not be accepted.
In the box meant for affixing the photograph, please paste your unsigned recent and identical colour photograph of size 3.5 cm x 3.5 cm..
Signature and thumb impression should be strictly within the box without touching the boundaries. Thumb impression should be of left hand in case of males and right hand in case of females. Putting thumb impression is mandatory and should be put in original as well as photocopied application forms. The thumb impression might, in future, be used for authentication by immigration authorities at the airports in India. Illiterate applicants should affix thumb impression in both the boxes meant for thumb impression as well as for signature.
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COLUMN 1 - NAME
The name upto 75 characters long can be given and filled in the form. The full name as it should appear in the Passport should be furnished here. For example,
Name: KARUR VAIKUNTA SUBRAMANIYAN RAMANATHAN PILLAI
Write the Surname as "PILLAI" in the boxes provided for Surname and put a comma and write "VAIKUNTA SUBRAMANIYAN RAMANATHAN" as the given name in the rest of the columns. Incase you do not have a surname, just write the given name. No initials should be written and they should be expanded.
COLUMN 2 - If you have ever changed your name, please indicate the previous name in full. This will be applicable to a person who has even marginally changed the name or a lady who has changed her name / surname subsequent to the marriage. If there is no change in name at all, kindly leave the column blank.
COLUMN 3 - Incase of Male / Female option, please write M or F as applicable in the box space provided. For eunuch, please write 'E' in this box.
COLUMN 4 - DATE OF BIRTH: The date of birth is filled as dd/mm/yy as shown in the birth certificate issued by Municipal / Government Authorities. Proof of date of birth is to be attached. Please see the relevant section concerning documents to be attached.
COLUMN 5 - PLACE & COUNTRY OF BIRTH: Incase born in India, please mention name of place like Village / Town, District, State and if born outside India, mention name of place and country. If born before partition of India, at a place which now falls within Pakistan or Bangladesh, please fill up the name of place followed by Country as "Undivided India".
COLUMN 6, 7 AND 8: The name of Father, Mother and Spouse is to be entered in the respective columns. Surnames, if any, in these columns should be mentioned after the given names. Incase the applicant is unmarried, column 8 asking for information on name of spouse may be left blank.
COLUMN 9 AND 10: Please give relevant details along with date of since residing at the given address, telephone No. with area code is required for the purpose of contacting incase additional information or document is required by Passport Office. Mobile phone No. would be useful for sending SMS message to the applicant for the same purpose.
COLUMN 11: Please give email address, if any.
COLUMN 12: If the period of residence given in Column 9 is less than one year on the date of application, please furnish the other addresses with duration of residence. For each additional place of stay during the last one year, two additional photocopies of the application form should be furnished. Forms may be photocopied, but photograph and signature in original are required on each form.
COLUMN 13: Please give details of previous passport held. Either the Previous Passport Number of the file number may be mentioned here along with date of issue and place of issue in the relevant boxes. Incase previously applied for passport but the same was not received / issued, then the details such as file number, date applied and place where applied should be furnished here. Suppression of facts may warrant penal action as per the section 12 of the Passports Act, 1967.
COLUMN 14: Details like educational qualifications, profession, visible distinguishing mark and height in centimeters are to be provided against the respective item.
COLUMN 15: The relevant entry as 'Yes' or 'No' should be marked in the box space provided. If working in Central / State Government, Public Sector Undertakings, Statutory Bodies, a "No Objection Certificate" from the concerned office should be attached as per 'Annexure B'. Otherwise, a declaration to the effect that the Head of the Department of the concerned office has been informed of the the application for Passport should be attached in original as per the specimen in 'Annexure C'.
COLUMN 16: Regarding citizenship, whether it is by birth, descent, registration or naturalization is to be recorded in the box space provided by either B/D/R/N as the case maybe. If possessed any other citizenship before Indian citizenship, then please furnish the previous citizenship in the blank space provided.
COLUMN 17: If ever travelled on Emergency Certificate (EC) or ever deported or repatriated to India at Government cost, then the details of EC number, date and place of issue alongwith original seizure memorandum, place and country from where deported or repatriated should be furnished in this column. Even if the EC details are not available readily, at least the place and country from where deported or repatriated should invariably be given here.
COLUMN 18: Please write Y or N as applicable. It may be mentioned that Indian citizens leaving the country are required to get a clearance from the Protector General of Emigrants, if they are going to certain countries and if the "Emigration Clearance Not Required (ECNR)" stamp is not endorsed in their passports. The applicant is eligible for ECNR endorsement if he/she falls in one of the following categories and provides documentary proof thereof:
LIST OF APPLICANTS ENTITLED TO EMIGRATION CHECK NOT REQUIRED STAMP (ECNR):
(I) (a) Persons going abroad in managerial capacity in Hotels/Restaurants, Tea-Houses or other places of Public resort etc. possessing specialized Degrees in these fields.
(b) All GAZETTED Government servants.
(c) All Income-Tax payers (including Agricultural Income-Tax Payees) in their individual capacity. Proof of assessment of income tax consultant and actual payment of income tax for last one year or copy of PAN card to be insisted upon, and not merely payment of advance tax. However, in most cases as an assessment order is not issued seperately by the income tax department, income tax returns which are stamped by income tax authorities can be accepted.
(d) All professional Degree holders, such as Doctors holding MBBS degree or equivalent degree in AYURVED or HOMEOPATHY, accredited Journalists, Engineers, Chartered Accountants, Cost Accountants, Lecturers, Teachers, Scientists, Advocates, etc.
(e) Spouses and dependent children till the age of 24 years of category or persons listed from (b) to (d).
(f) All persons who have been staying abroad for more than three years (the period of the three years could be either at a stretch or broken), and spouses and children till the age of 24 years of such persons. Photocopy of the pages where Immigration departure/arrival stamps from and to India are affixed should be submitted along with the application form.
(g) Seamen who are in possession of Indian or Foreign CDC or Sea Cadets. For Deck Cadets;
(i) who have passed final examination of three years B.Sc. Nautical Sciences Courses at T. S. CHANAKYA, MUMBAI; and
(ii) who have undergone three months Pre-Sea training at any of the Government approved Training Institutes such as T. S. CHANAKYA, T. S. REHMAN, T. S. JAWAHAR, MTI (SCI) and NIPM, CHENNAI, after production of identity cards issued by the Shipping Master, MUMBAI/KOLKATA/CHENNAI.
(h) All holders of Diplomatic/Official Passports.
(i) Dependent children of parents whose passports are classified as ECNR. In case of such children ECNR classification to be restricted until they attain 24 years of age.
(j) Persons holding Permanent Immigration, Visa, such as the visas of UK, USA and Australia.
(k) Persons holding Graduate or higher Degrees. (If final certificate not available, provisional certificate plus MARK SHEET to be produced and attested photocopies thereof to be attached.
(l) Persons holding 3 years Diploma equivalent to degree from a recognized institution like Polytechnics.
(m) Persons possessing certificates of vocational training from Government/Government recognized Institutions.
(n) Nurses possessing qualifications recognized under the Indian Nursing Council Act, 1947.
(o) All persons above the age of 60 years.
(p) Army staff with degree qualification obtained in the Army.
(q) Children adopted by foreign nationals.
(r) Children adopted by Indian citizens provided the parents of either of parents have ECNR facility endorsed on his/her passport. This facility will be valid till the child acquires the age of 24 years.
(II) No emigration clearance is required for visiting Bangladesh, Pakistan and all countries in Europe (excluding CIS states), North America, Australia, Japan, New Zealand, South Korea, South Africa, Singapore and Thailand.
The eligible category should be mentioned in the blank space provided under this column and supportive documents should be attached with the application. It may be mentioned that passport holders with 'ECR' endorsement travelling to countries other than mentioned above for any non-employment purposes are required to have the 'ECR' endorsement suspended each time from the offices of the Protector of Emigrants (POE) or designated Passport Offices, before they undertake the travel. For employment purposes, such passport holders require emigration clearance from the offices of POEs. Otherwise, they will be stopped from travelling at the port of exit. Applicants are, therefore, advised to apply for ECNR, if they are eligible, to ensure hassle-free travel abroad.
COLUMN 19: In this column, while applying for the first time for the minor children who are less than 18 years of age, the details of valid passports holding by the both or either parents should be furnished in the relevant column. Both the parents should also submit a declaration as per 'Annexure - H' along with the application. In case both the parents do not have valid passports, the facts as well as 'No Objection' for issuance of passport to their child may be given in the declaration as per 'Annexure - H', in such cases, the passport to their minor child will, however, be issued only after receipt of clear police verification report. In case the minor child who is between 15 and 18 years of age wishes to obtain a full validity of passport for 10 years, the same can be issued only after receipt of clear Police Verification report and on payment of fee equivalent to the normal passport fee for a 36 pages passport, as applicable for an adult. Otherwise, the validity of the passport is restricted to five years or attaining the age of 18, whichever is earlier. In case of applicants from the State of Jammu & Kashmir, the age limit for exemption from police verification, if either of the parents is holding a valid Indian passport is 10 years and the minor children above the age of 10 years; will be issued only on receipt of clear police verification report.
COLUMN 20: This column contains 3-items calling information on any criminal offence / proceedings or warrant or summons or arrests or order by a court prohibiting departure from India on the applicant. These items should be filled are properly. Copies of relevant judgement should be submitted. Seperations of any facts may lead to fine upto Rs.5,000/- per offence and other penalties as applicable under the Provisions of Passport Act, 1967 as amended from time to time.
COLUMN 21: This column is a self declaration made by the applicant about owing allegiance to the souvereignity, unity and integrity of India, not voluntarily acquiring the citizenship or travel document from any other country, etc. Also this column contains declaration in furnishing true information in the application form and aware that it is an offence under the Passport Act, 1967 from any wrong information or suppress of any material information in getting the passport. The applicant also declares that he has no other passport or travel document. Under the space provided, the signature or thumb impression (left hand thumb impression for male and right hand thumb impression for female) should be furnished along with date and place of application.
COLUMN 22: In this column, the name and address along with Mobile or Telephone number of person to be intimated in the event of death or accident is to be furnished.
COLUMN 23: All the documents that are attached as enclosures along with the application form should be listed in the blank spaces provided and signed by the applicant.
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SECTION IV - DOCUMENTS TO BE ATTACHED WITH THE APPLICATION
(In case the applicant is submitting the application himself / herself, self attested copies of all documents are required to be attached with the application form. Original documents should, however, also be produced for verification and are returned. In case the application is being submitted through a representative of the applicant carrying authoriy letter, the attestation of the documents has to be done by a GAZETTED Officer or Notary Public. In case of application sent by post, the copies of original documents are to be attested by a GAZETTED Officer or Notary Public.
(A) PASSPORTS
(1) While applying for a fresh passport attach two copies of the following documents:
(a) Proof of address (attach one of the following):
Applicant's ration card, appointment letter of reputed companies on letter head, water / telephone / electricity bill / statement of running bank account / Income Tax Assessment Order / Election Commission ID Card, Spouse's passport copy, parent's passport copy in case of minors.
(b) Proof of Date of Birth (attach one of the following):
Birth certificate issued by Municipal Authority or District Office of the Registrar of Births and Deaths;
Date of birth certificate or Nationality certificate from the school last attended by the applicant or any other recognized educational institution; or an Affidavit sworn before a Magistrate / Notary stating Nationality and date / place of birth as per the specimen in 'Annexure - A' by illeterate or semi-illeterate applicants. N.B.: In the case of applicant's born on or after 26.01.89, only Birth Certificate issued by the Municipal Authority or the Office of the Registrar of Births and Deaths is acceptable.
(c) Citizenship document if applicant is a citizen of India by Registration or Naturalization.
(d) Government / Public Sector / Statutory Body employees should submit "No Objection Certificate" in originals (Annexure - B) or Declaration of having informed your Head of Department in original (Annexure - C).
(e) If the applicant is eligible for 'ECNR' attach attested copy of the supported document (See COLUMN 18 of the INSTRUCTIONS AND GUIDELINES FOR FILLING UP THE APPLICATION FORM).
(f) If the applicant was repatriated at Government cost, enclose documents to show that the expenditure, if any, incurred by the Government of India on his / her repatriation has been fully refunded to the Government of India, Ministry of External Affairs.
(g) If the applicant was ever deported to India give details of Emergency Certificate / Passport.
(2) When applying for re-issue of a passport after 10 years, attach:
(a) Old passport in original with self attested photocopy of its first four and last four pages, including ECR / ECNR page.
(b) Document mentioned at (1)(d), if applicable.
(c) Document mentioned at (1)(e), if the old passport did not have ECNR stamp or it was issued when the applicant was a minor.
(3) When applying for a minor's passport attach:
(a) A Declaration from the parent's / legal guardians affirming the particulars furnished in the application about the minor child, not inclusion of the minor name in the either of the parent's passport etc. as per 'Annexure - H'.
(b) Attested photocopy of passport, if any, of both parents incorporating their present marital status.
(c) Original passports of parents should be presented for verification of particulars.
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N.B.: The consent of both parents is necessary for issue of passport of minors (below 18 years). Hence, both parents are required to submit a Declaration as per 'Annexure - H'. In case where the parent(s) is/are resident outside India, such consent from the parent(s), in the form of a sworn Affidavit, duly attested by the Indian Mission abroad, is acceptable. Atleast one parent of the minor child must hold a valid Indian passport, failing which passport to minor applicant shall be issued only after clear police report. Children of all age must apply for seperate passports. However, those below 15 years will be given 5 years validity passport or till 18 years of age. The children who wish to obtain a full validity passport for 10 years can be issued a passport only after the receipt of clear police verification report and on payment of fee as applicable for issue/reissue of an adult passport. In the case of single parents or of parents who are seperated but not formally divorced, an affidavit at 'Annexure - D' is to be submitted.
For Adopted Children:
In case of Adopted Children the following documents are to be furnished:
(i) Valid adoption deed registered as per Indian laws
(ii) In the case of Christians, Muslims and Parsis, a court order granting guardianship and allowing the child to be taken out of the Country.
(iii) Copy of the guarantee executed before the Court concerned.
(B) CHANGE OF NAME
I. Following marriage, remarriage or divorce:
(a) A woman applying for first time for a passport in her married name or for change of name/surname in existing passport due to marriage must furnish:
(i) Photocopy of the Husband's passport, if any, and
(ii) An attested copy of marriage certificate issued by Registrar of Marriage OR an affidavit from the husband and wife along with a joint photograph, (Specimen at 'Annexure - E').
(b) Divorcees applying for change of name OR for deletion of spouse's name in existing passport must furnish
(i) Divorce deed duly authenticated by court, OR
(ii) Deed poll/sworn affidavit (Annexure - F)
(c) Re-married applicants applying for change of name/spouse's name must furnish:
(i) Divorce deed/death certificate as the case may be in respect of first spouse, and
(ii) Document as at (a) above relating to second marriage.
II. In other circumstances for change of name, the applicant (both male and female) should furnish:
(i) Deed poll/sworn affidavit (Annexure - F)
(ii) Paper cuttings of two leading daily newspapers (one daily newspaper should be of the area of the applicant's permanent and present address or nearby area).
(C) OUT OF TURN ISSUE OF PASSPORT UNDER TATKAAL SCHEME
An applicant desiring to obtain his passport under TATKAAL Scheme in less than five weeks from the date of submission of the application form, a verification certificate as per the specimen of 'Annexure - G' should be submitted along with TATKAAL fee. The Passport Issuing Authority shall retain the right to verify in writing the authenticity of the Verification Certificate from the official who has issued it. All applicants seeking a passport out of turn under the TATKAAL Scheme are advised to meet the Passport Issuing Authority concerned along with the application, documentation and fee as specified. Police Verification shall be done in all cases of issue of passport.
(D) CASES OF LOST/DAMAGED PASSPORTS:
The applicant has to fill the passport application form and submit the same along with following deeds: In this case, however, only one copy of the application form is to be submitted and only one photograph is required on the first page of the application form.
(i) FIR in original
(ii) First and last four pages of old passport.
SECTION V - SPECIMEN OF AFFIDAVITS / DECLARATIONS
ANNEXURE 'A'
SPECIMEN AFFIDAVIT TO BE SUBMITTED BY ILLITERATE APPLICANTS AS PROOF OF DATE OF BIRTH IN CASE NO OTHER DOCUMENT MENTIONED AT PARA A(b) OF SECTION IV IS AVAILABLE
(To be executed on non-judicial stamp paper)
I, _____________________________S/oW/oD/o________________________ presently residing at____________________ hereby state as follows:
I was born on______________ at____________ situated in the District___________in the State of_____________ I have no documentary proof in support of my place and date of birth.
I do not possess any educational qualification and I am an illiterate person.
I take oath and solemnly declare/affirm that the particulars furnished by me above are correct and that I have not concealed or misrepresented any facts.
Place_____________
Date_____________
Verified on this_______________ day of________________ of the year______________that the contents of my above affidavit are true and correct to the best of my knowledge and belief and nothing in material has been concealed therefrom. The contents of the affidavit have been read out to me.
Deponent
Attested
Note: Affidavit to be attested by the Magistrate/Notary	Signature and official seal of attesting authoriy
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ANNEXURE 'B'
ALL CENTRAL GOVERNMENT EMPLOYEES, STATE GOVERNMENT EMPLOYEES, EMPLOYEES OF STATUTORY BODIES AND PUBLIC SECTOR UNDERTAKINGS ARE REQUIRED TO PRODUCE A NO OBJECTION CERTIFICATE
(on original Stationery)
Certified that SHRI/SHRIMATI/KUM____________________________is a temporary/permanent employee of this (office address)_______________________ from__________ (date)____________ and is at present holding the post of ________. This Ministry/Department/Organization has no objection to his acquiring Indian Passport. The undersigned is duly authorized to sign this No Objection Certificate.
Name & Designation
Tel. No.__________
ANNEXURE 'C'
INTIMATION BY AN EMPLOYEE TO HIS EMPLOYER OF HIS INTENTION TO APPLY FOR A PASSPORT
(for all central government employees, state government employees, employees of statutory bodies and public sector undertakings who are not producing a no objection certificate.)
(on official stationery)
Certified that I, SHRI/SHRIMATI/KUM_______________________________ am a temporary/permanent employee of this_______________________________ (office address) from _________ (date), and am at present holding the post of ________. I have intimated by employer of my intention to apply for a passport.
Name and Designation
Tel. No.___________
Date _____________
Signature & Seal of the Head of Office
(in acknowledgement of the receipt of the said intimation)
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ANNEXURE 'D'
AFFIDAVIT TO BE SUBMITTED WITH THE APPLICATION FOR A PASSPORT OF A MINOR CHILD BY EITHER PARENT (WHO ARE SEPERATED BUT NOT FORMALLY DIVORCED) OR BY A SINGLE PARENT OF THE CHILD BORN OUT OF WEDLOCK
(to be executed on non-judicial stamp paper)
I,____________________ (name of single parent) solemnly declare and affirm as follows:
1. That I am the mother/father of (name of the child) who is a minor child and on whose behalf I have made an application for his/her passport.
2. That I am judicially seperated from the mother/father of (name of minor).
OR
That no legally valid marriage ever existed between me and Mr./Ms. (the father/mother of the minor child).
OR
The father/mother of/name of the child has deserted me after conception/delivery.
3. That (name of the minor)..is exclusively under my care and custody since separation/delivery.
Date:	Signature & address of Deponent
(Sworn before the First Class Judicial Magistrate of Notary Public)
ANNEXURE 'E'
SPECIMEN AFFIDAVIT TO BE SUBMITTED ALONG WTIH APPLICATION FOR PASSPORT BY A WOMAN APPLICANT FOR CHANGE OF NAME AFTER MARRIAGE (JOINT AFFIDAVIT TO BE SUBMITTED ALONGWITH HER HUSBAND)
(to be executed on non-judicial stamp paper)
We 1. ______________________________________________________________________________________
(maiden name of wife)
2. _________________________________________________________________________________________
(name of husband)
solemnly declare and affirm as under:
1. That we are married under_______________Marriage Act/Rights/Customs and are living together as married couple since___________________ (date of marriage)
2. That___________________________________________ would henceforth be known as ________________________
(maiden name of wife)	(name of wife after marriage)
by virtue of our marriage.
3. That our joint photograph is affixed below.
Signature & address of Deponents
Date:	1. ________________________
2. ________________________
Note:
1. This affidavit may be sworn before a Magistrate/Notary.
2. The joint photograph of the couple is to be pasted on the bottom left hand side of the affidavit paper and attested by the Magistrate/Notary with his/her signature and rubber stamps (half on the photograph and half on the affidavit).
3. Declaration 2 above to be ignored by applicants who seek endorsement of name of spouse in respect of reissue of a previously issued passport.
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ANNEXURE 'F'
SPECIMEN AFFIDAVIT FOR CHANGE IN NAME/DEED POLL/SWORN AFFIDAVIT
(On non-judicial stamp paper)
By this deed I, the undersigned________________________________________ (New Name) previously called___________________________ (Old Name), doing_______________________ (give profession or vocation) and resident of ________________________ (address) solemnly declare:-
1. That for and on behalf of myself and my wife and children and remitter issue wholly renounce/relinquish and abandon the use of my former name/surname of ______________________ and in place thereof I do hereby assume from this dte the name/surname ____________ and so that I and my wife, children and remitter issue may hereafter be called, known and distinguished not by my former name/surname, but assumed name/surname of ______________________.
2. That for the purpose of evidencing such my determination declare that I shall at all times hereafter in all records, deeds and writings and in all proceedings, dealings and transactions, private as well as upon all occassions whatsoever use and sign the name of _____________________ as my name/surname in place and in substitution of my former name/surname.
3. That I expressly authorize and request all persons in general and relatives and friends in particular, at all times hereafter to designate and address me, my wife, my children, "remitter issue by such assumed name/surname of ___________ accordingly.
4. In witness whereof I have hereunto subscribed my former and adopted name/surname of __________ and ________ affix my signature and seal, if any, this ____________ day of ________.
Signed sealed and delivered by the above name
Former name _________________________
Date:
In the presence of:
Name_________________________	Name______________________________
Address_______________________	Address____________________________
(This deed poll/affidavit may be signed and attested in presence of a Magistrate/Notary or Consular Officer in an Indian Mission abroad)
Note: In case of change of name, applicant should insert advertisements in two reputed newspapers (one local newspaper of the area in which he/she is residing and 2nd in newspaper of the area of permanent address) and submit original newspapers at time of applying for passport in his/her new name.
ANNEXURE 'G'
SPECIMEN VERIFICATION CERTIFICATE
(on official stationery of veryfying authority)
Reference Number	Applicant's Photo
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(Verification Certificate issuing officer should attest the photograph of the applicant with his/her signature and rubber stamp in such a way that half the signature and stamp appear on the photograph and half on the certificate).
Verification Certificate
This is to certify that Sh./Smt./Kum. _________________________ son of/wife of/daughter of ________________________ whose personal particulars are given below has good moral character and reputation and that after having read the provisions of Section 6(2) of the Passports Act, 1967. I certify that these provisions are not attracted in case of this applicant and I, recommend issue of an Indian Passport to him/her. Applicant has been staying at his/her address continuously for the last one year.
Date of Birth _______________________________________
Place of Birth ______________________________________
Educational Qualification ______________________________
Profession (Govt./Private Service/Others)__________________
Permanent Address__________________________________
Present Address____________________________________
Place
Office Address with location
Date:
Office Seal
Signature____________________________
Full Name___________________________
Designation__________________________
I Card No.__________________________
(Enclose a photocopy of I Card)
Telephone No. (O)________ (R)_________
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Notes:
1. The applicant's passport size photograph is also required to be affixed on the Verification Certificate and attested by the officer issuing the Verification Certificate with his/her signature and rubber stamp in such a way that half the signature and stamp appear on the photograph and half on the certificate.
2. If the applicant has resided at more than one place during the last one year then all previous addresses with the relevant dates should be mentioned.
3. This Verification Certificate may be got signed by any of the following:
(i) A Deputy Secretary/Director/Joint Secretary/Add. Secretary/Special Secretary/Secretary/Cabinet Secretary to Government of India.
(ii) A Joint Secretary/Additional Secretary/Special Secretary/Chief Secretary to a State Government.
(iii) A Sub-Divisional Magistrate/Additional DM/District Magistrate of the district of residence of applicant.
(iv) A District Superintendent of Police/Range, DIG/IG/DGP of district of residence of applicant.
(v) A colonel and above or equivalent ranks in the Air Force and the Navy.
(vi) The General Manager of a Public Sector Undertaking.
(vii) All members of any All India Service or Central Service who are equivalent to or above the rank of a Deputy Secretary to the Government i.e. in the pay scale of Rupees 12,000-16,500 or above.
(viii) Resident Commissioners/Additional Resident Commissioners of all State Governments based in Delhi.
4. Anyone who issues incorrect verification certificate may be prosecuted under section 12(2) of the Passport Act, 1967.
5. SECTION 6(2) OF THE PASSPORT ACT, 1967
"Subject to the other provisions of this Act, the passport authority shall refuse to issue a passport or travel document for visiting any foreign country under clause (C) sub-section 5 of anyone or more of the following grounds, and on no other ground, namely:
(a) that the applicant is not a citizen of India.
(b) that the applicant may, or is likely to engage outside India in activities prejudicial to the sovereignity and integrity of India.
(c) that the departure of the applicant from India may, or is likely to be detrimental to the security of India.
(d) that the presence of the applicant outside India may, or is likely to prejudice the friendly relations of India with any foreign country.
(e) that the applicant has, at any time during the period of five years immediately preceding the date of his application been convicted by a court of India for any offence involving moral turpitude and sentenced in respect thereof imprisonment for not less than two years.
(f) that criminal proceedings in respect of an offence alleged to have been committed by the applicant are pending before a court in India.
(g) that a warrant or summons for the appearance, of a warrant for the arrest, of the applicant has been issued by a court under any law for the time being in force or that an order prohibiting the departure from India of the applicant has been made by any such court.
(h) that the applicant has been repatriated and has not reimbursed the expenditure incurred in connection with such repatriation.
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ANNEXURE 'H'
DECLARATION OF PARENTS/SINGLE PARENT OR GUARDIAN IF PASSPORT IS FOR MINOR: TO BE SIGNED BY BOTH THE PARENTS/SINGLE PARENT OR GUARDIAN)
I/We affirm that the particulars given above in respect of (name of the child)____________________ son/daughter of Shri.________________________ and Shrimati _______________________ of whom I/we am/are the Parents/Single Parents/ Guardians. I/we undertake the entire responsibility for his/her expenses. I/we solemnly declare that he/she has not lost, surrendered or been deprived of his/her citizenship of India and that the information given in respect of him/her in this application is true. It is also certified that I/we am/are holding/not holding valid Indian passport(s) andthe name of the child mentioned is not included in Passport of either parent.
Details of passport(s) held by both or either parent:
(father)	(mother)
Passport No. ______________________	________________________
(in case both parents do not hold passports, please write NO)
Date and Place of Issue: _____________________	________________________
Child's name included in Mother's/Father's passport __________________________________ on page No. ____________
AND/OR	OR
(Signature)	(Signature)
Mother and or Father	Guardian
Name & Signature/T.I., of both the Parents/Single Parent/Guardian (Left hand T.I. if male and Right hand T.I. if female)

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