Application Form For Misc. Services - Consulate Of India
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1
2CONSULATE GENERAL OF INDIA
PASTE
3 EAST 64TH STREET
ONE PASSPORT
(Bet. Madison and Fifth Avenue)
NEW YORK, NY 10065
SIZE
TEL (212) 774-0600. Fax (212) 570-9581
PHOTOGRAPH
E-mail:
HERE
For more information visit our website:
APPLICATION FOR MISCELLANEOUS SERVICES
PLEASE SPECIFY THE SERVICE APPLIED FOR: _____________________________________________________________
•
PLEASE READ INSTRUCTIONS CAREFULLY BEFORE FILLING IN THIS FORM. Instructions can be obtained from the Consulate General of
India, New York or from our web site. Incomplete application will not be accepted. This form may be duplicated if required. Effective 1 February 2004.
•
Applications are accepted from 9.15 A.M. to 12:15 P.M. on working days and passports delivered irrespective of date of application only between 4:30 to
5:15 P.M. Send exact amount of FEE either in the form of money order/certified check payable to Consulate General Of India or in CASH in bills no
larger than $50/-. WE DO NOT ACCEPT PERSONAL CHECKS. Use only one form of payment. DO NOT SEND CASH IF APPLYING by mail. Also
enclose payments (US$ 10 for priority mail or US$ 20 for Express mail) for return of ser viced documents by mail. We use only USPS express or certified
mail for return of documents.
1. FULL NAME (Expanded Initials)____________________________________________________________________________________________
(Surname)
(Given Names)
2. Applicant’s Driver’s License No. ___________________________________ Date and Place of issue _____________________________________
3. Permanent Address in India ___________________________________________________________________________Tel:_________________
4. Permanent Address in USA ___________________________________________________________________________ Tel:_________________
5. Profession & Business Address_________________________________________________________________________Tel:_________________
6. PLACE OF BIRTH _______________________________________ DATE OF BIRTH ________________________________________________
(Village/City & District)
(DD/MM/YY)
7. CURRENT PASSPORT NO. ____________________________ PLACE OF ISSUE ___________________________________________________
DATE OF I S SUE _____________________________________ DATE OF EXPIRY ___________________________________________________
(DD/MM/YY)
(DD/MM/YY)
8. NAME OF FATHER ____________________________________________________________________________________________________
9. NAME OF MOTHER ____________________________________________________________________________________________________
10.NAME AND NATIONALITY OF SPOUSE __________________________________________________________________________________
11.IS APPLICANT REGISTERED WITH THE CONSULATE GENERAL? IF NOT IS A MEMBER OF ANY INDIAN ORGANISATION? GIVE DETAILS
____________________________________________________________________________________________________________________
TYPE OF SERVICE(S) REQUIRED
(A) Kindly register following child/children and issue them Birth Certificate(s) as Indian citizens. For registration of a child, fill up a separate registration
form and pay US $ 20 per child in addition to US $ 20 for each child for the Birth Certificate. Particular of the child to be registered:
Child’s Name
Date & place of birth
Sex (M/F)
________________________________________________________________________________________________________________________
Male
________________________________________________________________________________________________________________________
Male
________________________________________________________________________________________________________________________
Male
NOTE: Original Birth Certificate of the child and original passports of parents along with photocopies is required.
(B) Kindly delete my child/children’s name from my passport. (Fee of US $ 10 required for each name to be deleted). Particulars of child/children:
Child’s Name
Date & place of birth
Sex (M/F)
________________________________________________________________________________________________________________________
Male
________________________________________________________________________________________________________________________
Male
________________________________________________________________________________________________________________________
Male
NOTE: Consent in the form of an affidavit (duly notarized) from both parents is required for deletion of child’s name. Submit passports of both parents
and original birth certificate of the child along with photocopy of these documents.
(C) Kindly change my address (permanent or in USA) as recorded in the passport (Fee US $ 10.00)
(a) Address as in passport _______________________________________________________________________________________________
(b) New Address _______________________________________________________________________________________________________
(D) Kindly issue me (Please check the Box)
1. Birth Certificate (US $ 20.00)
2. Police Clearance Certificate (US $ 20.00)
3. Life Certificate (for pensioners only – gratis)
4. Marriage Certificate (US $ 20.00)
6. Nationality Certificate US $ 20.00)
5. Non - Availability Certificate (US $ 20.00)
8. Attestation of documents (US$10/20/50)
7. Attestation for child’s passport (US $10)
9.Others (please specify)
PLEASE SEND YOUR PASSPORT(S) WITH APPLICATION FOR ANY OF THE ABOVE SERVICES AND GIVE REASONS FOR REQUESTING THE
CERTIFICATES/SERVICES.
DECLARATION
I solemnly affirm that
i) I owe allegiance to the sovereignty and integrity of India, and
ii) Information given above in respect of myself, my son/daughter/ward 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, which attract penal and other punishments under
the Acts,
iii) I have not lost, surrendered or been deprived of my citizenship of India, nor am I in possession of any other passport or travel document.
iv) I undertake to be entirely responsible for expenses of my daughter/ward.
Place ______________________
_______________________________________________
Date ______________________
Signature or thumb impression of applicant or
his/her legal guardian (Left thumb impression of
male and right thumb impression of female)
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