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PLEASE SUBMIT THE FOLLOWING AFFIDAVIT, DULY NOTARIZED

( This affidavit is required for the issue of New Passport)

AFFIDAVIT

I___________________________________________________, DAUGHTER / SON OF
                    Full Name

MR. _________________________________ AND MRS.________________________
                      Father's Name                                                                                           Mother's Name

NAME OF SPOUSE __________________________________________________

SOLEMNLY AFFIRM THAT:

I WAS BORN AT ________________________________________(NAME OF PLACE)

ON  ____________________________________________________________
(DAY)                    (MONTH)                      (YEAR)

• I HAVE NOT LOST, SURRENDERED OR BEEN DEPRIVED OF MY CITIZENSHIP OF INDIA. .

• I OWE ALLEGIANCE TO THE SOVEREIGNTY AND INTEGRITY OF INDIA. I HAVE NOT ACQUIRED OR APPLIED FOR CITIZENSHIP OF ANOTHER COUNTRY.

• I HAVE NEITHER TAKEN ASYLUM NOR APPLIED FOR ASYLUM / REFUGEE STATUS.

• I WILL TAKE UTMOST CARE OF MY PASSPORT, IF ISSUED, AND IN CASE OF LOSS / DAMAGE OF PASSPORT BY ME, THE GOVERNMENT OF INDIA WILL BE AT LIBERTY TO TAKE APPROPRIATE ACTION UNDER THE PASSPORT ACT, 1967.

THE ABOVE STATEMENT IS TRUE IN ALL RESPECTS.

DATE  _________________

PLACE  _______________________________            (SIGNATURE OF THE APPLICANT)

______________________________________________

(SIGNATURE AND SEAL OF THE NOTARY PUBLIC)