[To be filled in duplicate (2 copies)]
Consulate General of India
I ,___________________________________________________________, aged _______
residing in ____________________________________________, holder of Indian passport No.
_____________, issued at _____________________ on _____________, hereby make oath and
state as follows:-
1. That I intend to marry Mr./Ms. ____________________________________________, holder of
_________________Passport No. _____________ issued at _____________________________
on ___________, of my own free will.
2. That I am single/divorced/widow/widower.
3. That this affidavit is true.
4. That it conceals nothing and no part of it is false.
Sworn at the Consulate General of India, Houston, this day, the ___________________________ by
Mr./Ms. ________________________________________, who made his/her signature before me at
Houston. He/She has been identified by his/her passport No. _________________ issued at
The Consulate General of India, Houston take “NO RESPONSIBILITY” for the correctness of the