Transcription of APPLICATION FOR THE SURRENDER OF INDIAN PASSPORT ...
1 APPLICATION FOR THE SURRENDER OF INDIAN PASSPORT & renunciation OF INDIAN citizenship I have acquired Canadian/Foreign nationality on (Date) _____ and consequently have obtained Canadian/ Foreign PASSPORT . Therefore I hereby renounce my INDIAN citizenship and SURRENDER my INDIAN PASSPORT . My personal particulars are outlined below: (Please fill personal information as per INDIAN PASSPORT ) Given Name :_____ Surname :_____ Date of Birth :_____ Place of Birth :_____ Father s Name :_____ Mother s Name :_____ Spouse Name :_____ INDIAN PASSPORT details (Please fill in the columns below) PASSPORT Number:_____ Date of Issue :_____ Date of Expiry :_____ Place of Issue: :_____ Canadian/Foreign PASSPORT details (Please fill in the columns below) Nationality Acquired :_____ PASSPORT Number :_____ Date of Issue :_____ Place of Issue.
2 _____ Address :_____ :_____ Phone number :_____ Email :_____ I may be issued a SURRENDER certificate. I have retained a copy of my INDIAN PASSPORT and I will not ask for the same in future. DECLARATION: I solemnly affirm that the information given here is correct and nothing has been concealed and I am aware that it is an offence under the INDIAN PASSPORT Act, 1967 to knowingly furnish false information or suppress material information; Place_____ Signature_____ Date_____ Documents Required: 1. Refer BLS SURRENDER of INDIAN PASSPORT / renunciation of INDIAN citizenship checklist.
3 2. Relevant fee, penalties if applicable &BLS Service Charge Note: In case the INDIAN PASSPORT held at the time of acquiring Canadian citizenship is not available, a notarized affidavit explaining the circumstances of the loss/damage, detailed police report of lost PASSPORT , the PASSPORT number & date of issue/expiry must be provided, along with proof in support of the claim (For example Landing Document).
