Fillable Application For Miscellaneous Services printable pdf download

EMBASSY OF INDIA (CONSULAR WING)

2 5 36 Massachusetts Avenue, NW, Washington, DC 20008

PASTE

Tel: (202) 939-9867

Fax: (202) 387-6946

APPLICANT'S

APPLICATION FOR MISCELLANEOUS SERVICES

RECENT PHOTO

[This application may be used at the Embassy of India, Washington, DC or at

HERE (2”X 2”)

any other Consulate General of India in USA.]

(i) Please read the instructions at page 3 before filling the form

(ii) Please fill the form in BOLD letters.

(iii) For power of Attorney and Life Certificate sent by mail, the signatures of the

should be notarized.

(iv) Declaration at Section V should be signed by Indian Citizens only

PLEASE [X] MARK THE SERVICE APPLIED FOR:

[ ] Emigration Clearance waiver (Fee $10/-)

[ ] Endorsement on Identity Certificate (Fee $5/-)

[ ] Birth / Death/Marriage Certificate (Fee $20/) (Fill Section II also )

[ ] Police Clearance Certificate (Fee $20/-)

[ ] Attestation of civil documents (ffidavits, educational degree, sponsorship certificates, Willa , etc (Fee $10/-) (per signature)

[ ] Life Certificate (gratis) Mailing fee is required wherever applicable)

[ ] Attestation for property related documents; Power of Attorney to be filled in duplicate) (Fee $20/-) (per signature)

[ ] Attestation for Commercial Documents ( to be filled in duplicate)(Fee $50/-) (per signature)

[ ] Attestation for documents for sale, purchase of ship, vessel (to be filled in duplicate) (Fee $261/-)

[ ] No Obligation to Return to India (Fee $60/-)

[ ] Registration of Marriage (Fee $50/-)

[ ] Change of address, addition/deletion & other miscellaneous services on the passport (Fee $10/-) (Fill Section IV also)

[ ] Attestation of Driver’s License (Fee $10/-)

[ ] No Objection Certificate for carrying dead body/ashes (Fee $1/-)

[ ] NORI Waiver Certificate (Fee $20/-)

[ ] NRI Certificate (Fee $20/-)

[ ] Others (Please specify)___________________________________________________________________

1. APPLICANT’S NAME AS IN PASSPORT______________________________________________________________________________ _

Surname / Last Name

(Middle Name)

(Given / First Name)

(

)

2.FULL NAME OF FATHER

3. FULL NAME OF MOTHER: _______________________________

_____________________________________________

4. PLACE & COUNTRY OF BIRTH OF APPLICANT

: ______________________________________________________________________________________________

5. DATE OF BIRTH OF APPLICANT:( DD/MM/YYYY): ________________________________________________________________________

6. NAME AND NATIONALITY OF SPOUSE: _______________________________________________________________________________

7. PERMANENTADDRESS IN INDIA:

___________________________________________________________________________________________________________

_________________________________________________________________________________________________ ___________________________________________________

8. ADDRESS IN USA:: _

________________________________________________________________________________________________________________________ _

____________________________________________________________________________________________________________________________________________________

9. PROFESSION & BUSINESS ADDRESS: _______________________________________________________________________________

________________________________________________ TEL: __________________________

EMAIL:

____

_______________________________

10:CURRENT PASSPORT NO.:_________________________

11. PLACE & DATE OF ISSUE:___________________________________

12. DATE OF EXPIRY: ________________________________

PLACE

DATE

SIGNATURE

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Application For Miscellaneous Services

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