AFFIDAVIT FORMATS

Change in Name/Deed Poll/Sworn Affidavit

SPECIMEN AFFIDAVIT FOR CHANGE IN NAME/DEED POLL/SWORN AFFIDAVIT
(On Non-judicial stamp paper)

By this deed I, the undersigned.................................................. (New Name) Son/daughter/wife of....................................................................................called.................................. (old name) doing .........................(give profession or avocation) and resident of ............................ (address) solemnly declare:-

  1. That for and on behalf of Myself and My wife and children and remitter issue wholly renounce/relinquish and abandon the use of my former name/ surname of ................... and  in  place thereof I do hereby assume from this date the name/surname ................. and so that I and my wife and children remitter issue may hereafter be called, known and distinguished not by my former name/surname. but by assumed name/surname of   .....................................

  2. That for the purpose of evidencing such my determination declare that I shall at all times hereafter in all records, deeds and writings and in all preceedings, dealings and transactions, private as well as upon all occassions what-so-ever use and sign the name of ..................... as my name/surname in place and in substitution of my former name /surname.

  3. That I expressly authorize and request all persons  in  general   relatives and friends in particular at all times hereafter to designate and address me. my wife, my children. remitter issue by such assumed name/surname of .......................................... accordingly.

  4. In witness whereof I have here unto subscribed my former and adopted name/ surname of .............................................................. and ............................... affix my signature and seal. if any, this ............................ day of ...............................

Date ........................

Signed sealed and delivered by the above name
former name ...................................................
In the presence of   .............................................  

Name     .....................................
Address ......................................
 

Name
Address

(This deed poll/affidavit may be signed and attested in presence of a Magistrate or Consular Officer in an Indian mission abroad)

Note:
In case of change of name, applicant should insert advertisements in two reputed newspapers (one local newspaper of the area in which he/she is residing and 2nd in Newspaper of the area of permanent address) and submit original newspapers at time of applying for passport in his/her new name.

Affidavit for a Passport in Lieu of Lost / Damaged Passport

SPECIMEN OF AFFIDAVIT TO BE SUBMITTED WITH THE APPLICATION FOR
A PASSPORT IN LIEU OF LOST/DAMAGED PASSPORT
(To be executed on non-judicial stamp paper)

(This affidavit is to be Executed on non-judicial stamp paper of appropriate value in the presence of magistrate first Class on the following points)

I .................................S/o/d/o/w/o/............................. residing at............ solemnly affirm as follows :

  1. State how and when the passport was lost/damaged and how many passports were lost/damaged Earlier ?

  2. State whether you travelled on the lost/damaged Passport if so. state flight number last date and port of entry into India?

  3. State whether you availed of any TR concessions/FTs allowance and if so details thereof?

  4. State whether non-resident Indian and if resident abroad. the details of the residence as Follows:

SI.
No.		 Name of the
Country		 length of residence
From     To        
(details if available)		 Page Nos. of passport
bearing  departure & arrival stamps

1

2

3

      

 

I further affirm that I will take utmost care of my passport if issued and the Government will be at liberty to take any legal action under the Passport Act, 1967,if the lapse is repeated.

Date Deponent
Affirmed before First Class Magistrate

Affidavit to be Declared / Affirmed by Legal Guardian of the Minor

SPECIMEN AFFIDAVIT TO BE DECLARED/AFFIRMED BY
LEGAL GUARDIAN OF THE MINOR
(To be executed on non-judicial stamp paper)


I ...........................................................(name of guardian) solemnly declare and affirm as follows:

 

  1. That I am the legal guardian of ........................................(name of minor) who is a minor and on whose behalf I have made an application for a passport.

  1. That ................................................................................................... (name Of the minor) has been living in India under my guardianship.

  2. That I have no interest adverse to that said   ........................................................... (Name Of Minor)

  3. That I have applied for a passport for ..................................................... (name and address of minor) under the instructions of .................................................. (name and address of minor's parent and his full address abroad).

This affidavit may be sworn in the presence of Magistrate.

Date: Signature and address of Deponent

SPECIMEN AFFIDAVIT TO BE DECLARED/ AFFIRMED BY
TWO RESPONSIBLE PERSONS WHO KNOW THE LEGAL GUARDIAN
AS WELL AS THE MINOR
(To be executed on non-judicial stamp paper)

I.................................... (name of deponent) s/o/d/o .......................................  do solemnly declare and affirm as follows:

  1. That I know both Shri/Smt................................................... (name of guardian) S/o/d/o ....................................... and ..................................... (name of minor) ..................................... s/o/d/o ...................................... and name of guardian ................................ is the legal guardian of ................................ (name of minor)

  2. That...................................... (name of guardian) has applied for a passport in favour of  ............................................ (name of minor) under the instructions of his/her ...........................(name and address of minor's parents residing abroad).

  3. That................................. (Name of guardian) has no interest adverse to that of said ........................................ (name of minor).

  4. That.................................. (name of guardian) is ....................................................   (relationship)  of .................................. (name of minor)

    This affidavit may be sworn in the presence of magistrate

Date: Signature and address and designation of Deponent

No Objection Certificate

ALL CENTRAL GOVERNMENT  EMPLOYEES,
STATE GOVERNMENT EMPLOYEES,  EMPLOYEES OF
STATUTORY BODIES AND PUBLIC SECTOR UNDERTAKINGS
ARE REQUIRED TO PRODUCE  A NO OBJECTION CERTIFICATE
(on Official Stationery)


Certified that Sri/Smt/kum............................... is a temporary/permanent employee of this  ..................................................................... (office address) from.................. (date), and  is at present holding the post of ............................. This Ministry/ Department/Organisation  has no objection to his acquiring Indian Passport. The undersigned is duly authorised to sign this No Objection Certificate.

Date: Name and Designation
Tel. No.:

Affidavit to be submitted by Illiterate Applicants

SPECIMEN AFFIDAVIT TO BE SUBMITTED BY ILLITERATE APPLICANTS
AS PROOF OF DATE OF BIRTH IN CASE NO OTHER DOCUMENT
MENTIONED AT PARA 6(v) OF THE INSTRUCTION BOOKLET IS AVAILABLE
(To be executed on non-judicial stamp paper)

I.................................... S/o/W/o/D/o........................................... hereby state as follows:
I was born on........................... (date) at............................ situated in the District .........................in the State of ..................................... I have no documentary proof in support of my place and date of birth.
I do not possess any educational qualification and I am an illiterate person.
I take oath and solemnly declare/affirm that the particulars furnished by me above are correct and that I have not concealed or misrepresented any facts.

Place..................
Date:..................

Verified on this.................. day of ..................... of the year .........................  A.D that the contents of my above affidavit are true and correct to the best of my knowledge and belief and nothing in material has been concealed therefrom.

The contents of the affidavit has been read out to me.

Deponent:
Attested:

Signature and Official seal of attesting authority

Note: Affidavit to be attested by a magistrate.

Verification Certificate

SPECIMEN VERIFICATION CERTIFICATE

(on official stationery of verifying authority)


This is to certify that Mr/Miss/Mrs........................ S/o/D/o/W/o ...................................... resident of ............................................ (address), and whose photograph and signature are attest below has good moral character and reputation and that after having read the provisions of section 6(2) of the Passports Act. 1967 (Printed below). I  certify that these provisions are not  attracted   in  case  of  this   applicant    and  I,  therefore recommend issue  of  an Indian passport to  him. Applicant has been staying  at  his  address continuously for the last two years.

Place
Date		 Signature

 
(Complete name with designation)
Tel No. Office .............................
Residence


Tel No. Office .............................
Residence ...................................
                                                            
(Photograph of applicant to be pasted here. Applicant should sign across the photograph. Applicants photograph and signature to be attested by verifying authority.)

Note:

 

  1. The applicant's Passport size photograph is also required to be affixed on the verification Certificate and attested by the officer issuing the Verifying Certificate with his/her signature and rubber stamp in such a way that half the signature and stamp appear on the photograph and half on the certificate.

  2. This verification certificate may be got signed by any of following:
    (i) A Deputy Secretary/ Director/ Joint Secretary/ Add Secy./ Spl. Secy./ Secy./ Cab.Secy. to the Govt. of India.
    (ii) A Joint secretary/ add. Secy / Spl. secy./ Secy./ Chief Secy. to a state Govt.
    (iii) A Sub-Divisional Magistrate/ Additional DM/ District Magistrate of the district of residence of applicant.
    (iv) A District Supt.of Police/Range, DIG/ IG/ DGP of district of residence of applicant.
    (v) A Colonel and above or equivalent ranks in the Air Force and the Navy
    (vi) The General Manager of a Public Sector Undertaking.

  3. Anyone who issues incorrect verification certificate may be prosecuted under section 12 (2 ) of the passports Act. 1967.

  4. SECTION 6(2) OF THE PASSPORTS ACT. 1967.
    "Subject to the other provisions of this Act, . the passport authority shall refuse to Issue a passport or travel document for visiting any foreign country under clause (c) sub-section (2 ) of section 5 on any one or more of the following grounds. and on no  other grounds namely:-

    That the applicant is not a citizen of India.

    That the applicant may, or is likely to engage outside India in activities prejudicial to the sovereignty and integrity of India.

    That the departure of the applicant from India may, or is likely to, be deterimental to the security of India.

    That the presence of the applicant outside India may, or is likely to prejudice the friendly relations of India with any foreign country.

    That the applicant has, at any time during the period of five years immediately preceding the date of his application been convicted by a court in India for any offence involving moral turpitude and sentenced in respect thereof to imprisonment for not less then two years.

    That criminal proceedings in respect of an offence alleged to have been committed by the applicant are pending before a court in India

    That a warrant or summons for the appearance, or a warrant for the arrest, of the applicant has been issued by a court under any law for the time-being in force or that an order prohibiting the departure from India of the applicant has been made by any such court.

    That the applicant has been repatriated and has not reimbursed the expenditure incurred in connection with such repatriation.

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