Fillable Passport Application Form (Page 6 of 6) in pdf

Passport Application Form Page 6

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8.2 Have you at any time during the period of 5 years immediately preceding the date of

Yes

this application been convicted by a court in India for any criminal offence & sentenced

to imprisonment for two years or more?

If yes, fill Column 7.2 of Supplementary Form

8.3 Have you ever been refused or denied passport?

Yes

If yes, give reason for refusal or denial of Passport in Column 7.3 of Supplementary

Form

8.4 Has your Passport ever been Impounded or Revoked?

Yes

If yes, provide details in Column 7.4 of Supplementary Form

8.5 Have you ever applied for/ been granted political asylum to/ by any foreign country?

Yes

If yes, provide details in Column 7.5 of Supplementary Form

8.6 Have you ever returned to India on Emergency Certificate (EC) or were ever deported

Yes

or repatriated?

If yes, provide details in Column 7.6 of Supplementary Form

9. Fee Details (Not to be filled by applicants submitting the application at Passport Seva Kendra)

9.1 Fee amount in (Rs)

9.2 If paid by Demand Draft (DD), provide the following details

DD Number

DD Issue Date

DD Expiry Date

Bank Name

Branch

10. Enclosures

10.

11. Self Declaration

I owe allegiance to the sovereignty, unity & integrity of India, and have not voluntarily acquired citizenship or

travel document of any other country. I have not lost, surrendered or been deprived of the citizenship of India

and I affirm that the information given by me in this form and the enclosures is true and I am solely

responsible for its accuracy, and I am liable to be penalized or prosecuted if found otherwise. I am aware that

under the Passports Act, 1967 it is a criminal offence to furnish any false information or to suppress any

material information with a view to obtaining passport or travel document.

Place

Signature/ Left Hand

Thumb Impression of

Applicant (If applicant is

minor, either parent to

Date (DD-MM-YYYY)

sign)

Page 6 of 6

Passport Application Form Page 6

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