Form 1 - Passport Application Form (Page 3 of 3) in pdf

Form 1 - Passport Application Form Page 3

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:

1) Information given above in respect of __________________________________ of whom I am the parent / legal

guardian is true.

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

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

4) I hereby declare that ________________________________ born in UK has not applied for or acquired U.K.

citizenship / travel document. Should I approach the British authorities for such a travel document, I undertake to

inform the High Commission of India, London immediately so that Indian travel document may be withdrawn.

________________________________________________

Signature of both the Parents /legal guardian.

Place :_________________________

Date: __________________________

Form 1 - Passport Application Form Page 3