Form "A" Dip 1 Passport Forms Page 2

DECLARATION

17.

I declare on solemn affirmation as under: -

(1)

To the best of my knowledge and belief the information given in this application is correct.

(2)

I have not previously held or applied for a passport of any description or been refused passport facilities.

(3)

All previous passports granted to me have been surrendered other than the passport or travel document noted below which

is now attached and that I made no other application for a passport since the attached passport or travel document was

issued to me

(a)

No. of attached passport/ travel document ………………………………………………………………………………………………………………

(b)

Date of Issue …………………………………………. ( c) Place of Issue ……………………………………………………………………………

Note:

If the applicant had a passport which has been lost, he should furnish particulars as per Sub para (4) below.

(4)

The passport as per details given below has been lost. In the event of its coming again into possession I undertake to return

it to the Regional Passport Office.

(a)

Passport No. …………………………………………………

(b) Date of Issue ……………………………………………………………………

(c) Place of Issue ………………………………………………….

(d)

Circumstances in which passport was lost or destroyed and measures taken to recover it ………………………………………………………...

(5)

I have never been repatriated at Government expenses.

(6)

I am/am not a Government servant, an employee of a semi-Government body, a municipality, any other local body or State-

owned Industry.

(7)

I have/have not served in the Armed Forces.

(8)

I am/am not reservist in the Armed Forces.

DECLARATION IN CASE OF MUSLIMS

I, ………………………………………………………………………. S/O ………………………………………………………………………………. Aged ……………………

years, adult Muslim, resident of ……………………………………………………………………………………………….. hereby solemnly declare that: -

(i)

I am Muslim and believe in the absolute and unqualified finality of the prophethood of Muhammad (peace be upon him) the last of the prophets.

(ii)

I do not recognise any person who claims to be a prophet in any sense of the word or of any description whatsoever after Muhammad

(peace be upon him) or recognise such a claimant as prophet or a religious reformer as a Muslim.

(iii)

I consider Mirza Ghulam Ahmad Quadiani to be an impostor nabi and also consider his followers whether belonging to the Lahori or

Quadiani group to be Non-Muslim.

Signature & Thumb Impression (with name

letters of applicant in indelible ink)

Date: ……………………………

---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

------

ATTESTATION

Applicable in cases of persons who have not attained the age of 18 years and are not issued with Identity card under the National

Registration Act, 1973.

I, as Father/Guardian/Attestor hereby attest that the information given above is correct to the best of my knowledge and belief

and that the photograph on page 1 of this application bears the true likeness of the applicant.

Signature of Father/Guardian/Attestor

Address ………………………………………………….

N.I.C. no………………………………………………….

Date ………………………………………………………

Place of Issue …………………………………………..

---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

----

FOR OFFICIAL USE ONLY

1. No. of Passport issued …………………………………………..

2. Date of Issue ……………………………………………………..

3. Date upto which Passport is valid ………………………………

Authority ………………………………………………………………..

Name ……………………………………………………………………