Application For Indian Passport (Page 2 of 2) in pdf

20. IS THIS APPLICATION FOR A PASSPORT FOR THE

FIRST TIME

NEW PASSPORT IN REPLACEMENT OF AN EXPIRED PASSPORT

DUPLICATE PASSPORT?

21. IF THIS APPLICATION IS FOR DUPLICATE PASSPORT, WAS THE PREVIOUS PASSPORT

LOST

DAMAGED

(If damaged, please attach damaged passport)

22.

PRESENT PASSPORT NO. OR DAMAGED OR LOST PASSPORT NO.

II) PLACE OF

I) DATE OF ISSUE

III) DATE OF EXPIRY

ISSUE

23. a.) WERE YOU EVER REFUSED A PASSPORT?

Yes

b.) WAS YOUR PASSPORT EVER ORDERED TO BE IMPOUNDED OR REVOKED?

Yes

IF ANSWER TO ANY OF THESE QUESTIONS IS “YES,” PLEASE ENCLOSE A COPY OF THE OFFICIAL COMMUNICATION RECEIVED

BY YOU AND GIVE OTHER DETAILS.

24. HAVE YOU EVER APPLIED FOR ASYLUM OR REFUGEE STATUS IN THE LIBYA/MALTA? IF YES, PLEASE

Yes

ATTACH RELEVANT DOCUMENTS.

25. a.) BRIEFLY STATE CIRCUMSTANCES OF LOSS/THEFT/DAMAGE OF PASSPORT AND ATTACH REPORT LODGED WITH LOCAL

POLICE IN CASE OF LOSS OF PASSPORT. (PLEASE ATTACH YOUR EXPLANATION ON A SEPARATE SHEET OF PAPER)

b.) DETAILS OF RESTRICTION, IF ANY, PUT ON APPLICANT’S DAMAGED/LOST PASSPORT

26. DETAILS OF THE SERVICE REQUIRED:

(IF APPLYING FOR MISC. SERVICE)

SPECIMEN SIGNATURE OF APPLICANT ONLY

(THUMB IMPRESSION, IN CASE OF AN INFANT)

Registration No. with Indian Embassy, Tripoli ________________

SELF DECLARATION :

I OWE ALLEGIANCE TO THE SOVEREIGNTY & INTEGRITY OF INDIA AND HAVE NOT VOLUNTARILY ACQUIRED THE CITIZENSHIP OR

TRAVEL DOCUMENT OF ANY OTHER COUNTRY. I HAVE NOT LOST, SURRENDERED OR BEEN DEPRIVED OF CITIZENSHIP OF INDIA.

THE INFORMATION GIVEN BY ME IN THIS FORM AND ENCLOSURES IS TRUE AND I AM SOLELY RESPONSIBLE FOR ACCURACY. I AM

AWARE THAT IT IS AN OFFENCE UNDER PASSPORT ACT, 1967 TO FURNISH ANY FALSE INFORMATION OR TO SUPPRESS ANY MATERIAL

INFORMATION WITH A VIEW TO OBTAINING PASSPORT OR ANY OTHER TRAVEL DOCUMENT.

I FURTHER DECLARE THAT I HAVE NO OTHER PASSPORT / TRAVEL DOCUMENT.

____________________________________________

(Signature or thumb impression of applicant)

Declaration by Parents/Legal Guardian in case of Minor:

Information given above in respect of __________________________________ of whom I am the parent / legal guardian is true.

I undertake to be entirely responsible for his / her expenses.

I solemnly declare that he / she has not lost, surrendered or been deprived of his/her citizenship of India.

I hereby declare that ________________________________ born in Libya/Malta has not applied for or acquired Libya/Malta citizenship /

travel document. Should I approach the Libyan/Maltese authorities for such a travel document, I undertake to inform the High Commission of

India, Malta immediately so that Indian travel document may be withdrawn.

________________________________________________

Signature of both the Parents /legal guardian

Place :_________________________

Date: __________________________

Application For Indian Passport Page 2

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