Application Form Miscellaneous Services On Indian Passports

Application Form Miscellaneous Services On Indian Passports - Moscow Embassy Page 2

4. Profession/Designation: __________________________________________________

5. Name of the Company/Organization: _______________________________________

6. Company/Business Address: ______________________________________________

________________________________________________________________________

Tel: ____________________________ Mobile No: ______________________________

E-mail: _________________________________________________________________

7. Is applicant registered with the Indian Mission/Post? If not, is he a member of any

Indian Organization? Give details. ___________________________________________

8. (i) Name of Father:

(ii) Name of Mother:

(iii) Name of Spouse and Nationality:

9. Current Passport No.: ___________________________________________________

Place of issue: ____________________________ Date of issue: _________________

Valid until: ___________________

Note: Separate passport will be issued to children of all ages. However, children below

15 years of age will be given a 5 year maximum validity passport only.

10. DECLARATION:

I solemnly affirm that:

I owe allegiance to the sovereignty, unity and integrity of India.

Information given above is correct and nothing has been concealed and I am aware that it

is an offence under the Passport Act 1967 to knowingly furnish false information or

suppress material information and

I undertake to be entirely responsible for expenses of my son/daughter/ward.

____________________________________

Signature of applicant or Thumb Impression

of his legal guardian.(Left hand thumb impression

Incase of male and right hand thumb impression

Incase of female)

Place _______________________________ Date: ______________________________

11. Two specimen signatures or thumb impressions required for service within the spaces

given bellow:

Embassy of India, Moscow

Application Form Miscellaneous Services On Indian Passports - Moscow Embassy Page 2