High Commission of India
Wellington, New Zealand

 

APPLICATION FORM FOR MISCELLANEOUS SERVICES ON INDIAN
PASSPORTS

 

 

 

 

 

(For use in Indian Mission/Post)

 

(a)  Police Clearance Certificate (PCC)

(b) Certificate of Birth

(c) Attestation/Power of Attorney

(d) Additional Endorsement
(e) Any Other Service (
please specify)

(Please Delete inapplicable)

Payment of fee (to be filled by applicant)
Amount paid $ ________________ by ________________ Mode of Payment.



Please paste one
Photograph of size of
35 mm X 45 mm &
enclose three for
additional booklet

 

 

 

 

 

1.

Full Name (firstname, middlename, lastname)

_________________________________________________

2.

Applicantís Date of Birth

_________________ Place of Birth _____________________

3.

Applicantí s Car Driving Licence No.

____________ Date & Place of issue ____________________

4.

Residential Address: In India

_____________________________ Phone: ______________

 

In Country of domicile

_____________________________ Phone: ______________

5.

Profession & Business address

__________________________________________________
_____________________________ Phone: ______________

6.

Is Applicant registered with the Indian Mission / Post ? If not is he a member of any Indian Organization ? Give Details

__________________________________________________

7.

Name of Father

__________________________________________________

 

Name of Mother

__________________________________________________

 

Name of Spouse & his/her Nationality

__________________________________________________

8.

Current Passport Details

Passport No. ______________ Valid until _______________

 

Place of Issue

_____________________    Date of Issue _______________

9.

Did applicant ever possess or
possesses any other  nationality or travel document of any
other country, if so, please give details

_______________________________________________
(Dual nationality holders please submit both passports along with applications.)

 

 

 

 

 

Note: In case of fresh inclusion or inclusion on a new passport in lieu of lost / damaged passport, enclose (i) birth certificate (s) bearing names of both parents (ii) passports of both parents and (iii) marriage certificate of parents. Children below fifteen years of age can wither apply for inclusion in their parentís passports, generally motherís or apply for separate passports. Children above fifteen years must apply for separate passport.

 

 

 

 

 

Space for additional Information if any you would like to give:

____________________________________________________________________

____________________________________________________________________

 

 

 

 

10.

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 and,
(iii) I undertake to be entirely responsible for expenses of my
son/daughter/ward.

 

Place: ________
Date
: _________

 

 

_____________________________________________
Signature of applicant or T.I or
his legal guardian
(Left hand T.I
in case of male and right hand T.I in case of female.)

 

 

 

 

_____________________________________________

 

_____________________________________________
Specimen signature or T.I within the space given above:

 

 

 

 

 

 

 

 

 

 

 

NOTE :
1)
Kindly send three photographs (one pasted on the application form) and sizes of the
photographs should be 35 mm x 45 mm.
2) Write name at the back of the photograph being enclosed.
3) Please do not staple the photographs.
4) Fee should be paid in the form of a Banker's Cheque in the name of "High Commission
of India, Wellington" . Personal cheques/money orders are not
accepted.
5) To avoid inconvenience, the application form should be filled-in neatly and clearly, preferably in capital letters.
6) Specimen signatures/thumb impression should be within the boxes provided in the last
page of the application
7) Incomplete application forms will be returned to the applicant without providing the
service.
8) It is advised that self-addressed (signature required) return courier pack may be sent
alongwith the application.
9) High Commission will not be responsible for loss or damage to the passport in transit.
10) ACKNOWLEDGEMENT: Please send a separate acknowledgement envelope, if you (the applicant) want acknowledgement of the receipt of the passport.

 

 

 

 

 

Forms in Hindi can be obtained from High Commissionís office in Wellington.

 

 

 

 

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© 2003, Indian High Commission, New Zealand. All rights reserved.