EMBASSY OF INDIA, ABU DHABI / CONSULATE …

1 1 Form No. EAP-I External EMBASSY OF india , ABU DHABI / CONSULATE GENERAL OF india , DUBAI, UAE APPLICATION FORM FOR AN INDIAN PASSPORT Fee Details - Passport Booklet of 36 pages Tatkal Scheme: (Additional). Note: All fields are mandatory and have to be filled Specimen Signature Amount of fee (paid in cash): (UAE Dhs.) _____ (to be filled in by the applicant) 1. i) Given Name _____ ii) Surname _____ iii) Aliases, if any _____ iv) Has applicant ever changed his/her name?

2 If so, give previous name in Full _____ v) Maiden name, if applicant is a married woman _____ vi) Sex (Tick mark) : Male Female 2. i) Date of birth: DD MM YYYY ii) Place & country of birth _____ iii) Height _____ Color of eyes _____ iv) Hair _____ v) Visible distinguishing marks, if any _____ 3. Permanent Address: (If different from current Passport, please attach documentary evidence of change, like Nativity Certificate in original issued by District Collector/ Tehsildar/Commissioner/Panchayat or copies of ration card, voter s ID card, Income tax receipt ,water, electricity or telephone bill attested by the state government authorities) (ii) In india : _____ _____ _____ (iii) Address is UAE (Complete Address.

3 No PO Box Nos.) _____ _____ Please paste one 51mm X 51mm recent photograph here. 2 4. (i) Name of Father _____ Country of his birth _____ (ii) Name of Mother _____ Country of her birth _____ (iii) Nationality of father at the time of applicant s birth _____ (iv) Nationality of mother at the time of applicant s birth _____ 5. Married Unmarried (Tick mark) 6. Name & Nationality of Spouse _____ 7. (i) Name of applicant s eldest son or daughter (First child) _____ (ii) Name of applicant s eldest brother or sister _____ (iii) Particulars of person to be intimated in the event of death or accident 8.

4 Present Passport Date & Place of issue _____ 9. (i) Local Car Driving License No. _____ (ii) Date & Place of issue _____ (iv) Local Labour Card No. _____ (iv) Date & Place of issue _____ (v) Local Health Card No. _____ (vi) Date & Place of issue _____ (vii) Any other Identity Card issued locally & held by the applicant No. _____ Date of issue _____ Place of issue _____ Authority issuing it _____ 10. Educational Qualification _____ 11. (i) When did applicant first leave india _____ (ii) When was he/she in india last _____ 12.

5 How long has applicant continuously resided abroad? _____ 13. Present Emigration Status ( ECR or ECNR ) _____ (With documentary evidence)(Attach photocopy of ECR/ECNR page of passport) 14. (i) Profession and business address* _____ (ii) Telephone/Telex/Fax/E-Mail _____ (*Please give complete physical location and not just the Box no. Please indicate Flat/ Apartment/Villa no. / Name of the Building, No/Name of the Street, Area/Zone Important landmarks to help identify the building etc. Telephone/ telex/ fax no.)

6 And E-mail address, if any) IN UAE Name: _____ Address: _____ _____ _____ IN india Name: _____ Address: _____ _____ 3 15. Please mention, if citizen of india by birth/descent/naturalization/Registratio n _____ 16. Did applicant ever possess any other nationality or travel document of any other country? If so, please give details? _____ 17. Was applicant ever refused an Indian Passport? (Yes/No) 18. Was applicant s passport ever impounded/revoked? If so, details please (Yes/No) 19.

7 Name and address of two relatives/friends, in india and in UAE 20. Is applicant in Govt. Service/working for an Indian Public Sector Undertaking/ Statutory Body? If so, please give details and enclose No Objection Certificate from your employer in original _____ 21. (i) Are any criminal proceedings pending against applicant in any court in india ? If so, please give details _____ (ii) Has applicant ever been repatriated from abroad to india at the expenses of the Govt.

8 Of india ? If so, details please _____ 22. (i) No. of lost/damaged passport _____ Place of issue _____ (ii) Date of issue _____ Valid until _____ IN india Name: _____ Address: _____ _____ IN UAE Name: _____ Address: _____ _____ _____ Name: _____ Address: _____ _____ Name: _____ Address: _____ _____ 4 23. (i) Briefly state circumstances of loss/theft/damage of passport on a plain paper and attach copy of report lodged with local police in case of loss/theft (ii) Give details of restriction, if any, imposed on applicant s damaged/lost passport (iii) Did applicant avail himself/herself of transfer of residence, foreign travel scheme or any other facility like gold/silver import on lost/damaged passport?

9 If so, details please _____ _____ 24. Is applicant registered with this EMBASSY or our CONSULATE General in Dubai? If not, is he a member of any Indian Organisation/Associations? 25. Particulars of children, if any, to be deleted from the passport: Name Place & Date of birth Sex (M/F) _____ _____ _____ _____ _____ _____ _____ _____ _____ 26. DECLARATION I solemnly affirm that: (i) I owe allegiance to the sovereignty, unity and integrity of india and have not voluntarily acquired the citizenship or travel document of another country.

10 I have not lost, surrendered or been deprived of citizenship of india . (ii) The 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 and the rules made thereunder to knowingly furnish false information or suppress any material information, which attracts penal and other punishments under the Act. (iii) I undertake the entire responsibility for expenses of my son/daughter/ward.