Application Form For Miscellaneous Services On Indian Passports Page 3

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9.
DECLARATION
I solemnly affirm that:
(i)
I owe allegiance to the sovereignty and integrity of India
(ii)
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
(iii)
I undertake to be entirely responsible for expenses of my son/daughter/ward
______________
Signature of applicant or T.I. of his legal
Guardian (Left hand thumb impression of
Male and right hand thumb impression of female)
Place__________________
Date:__________________
10.
Two specimen signatures or thumb impressions required for service (c) within the space
given below:
FOR OFFICE USE

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