Form No. 1E - Embassy of India Kuwait

1 form No. 1E Page 1 of 8 APPLICATION form FOR INDIAN passport AT AN INDIAN MISSION/POST New passport in lieu of Damage/Lost passport Please paste one 35mm x 45mm photograph here and enclose two more photographs Applicant must paste one photograph above with half the signature on the photograph and half on the application (Please delete whatever is inapplicable) 1. Full name (Surname) Aliases, if any Has applicant ever changed his/her name?

2 Is so, give previous name in full Maiden name, if applicant is a married woman 2. Date of birth Place of birth Country Height cms Color of eyes Color of Hair Visible distinguishing marks, if any 3. Permanent address In India In country of domicile 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 Name & Nationality of Spouse 6. Name of applicant s eldest son or daughter ( first child) 7. Name of applicant s eldest brother or sister 8. Present passport /national identity card, if any No. Date &place of issue 9.

3 Local car driving License No. Date & place of issue 10. Educational qualification (In order to determine emigration status) 11. When did applicant first leave India When was he/she in India last 12. How long has applicant continuously resided abroad? 13. Present Emigration Status (ECR or ECNR) (With documentary evidence ) Page 2 of 814. Profession and business address Telephone 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.

4 (Yes /No) 19. Name and address of two relatives/friends 20. Is the applicant in Govt. Service/Public Undertaking Service/Statutory Bodies Service of India ? 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. of India ? If so, details please 22. passport No. of lost/damaged passport Place of issue Date of issue Valid until (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.

5 (ii) Give details of restriction, if any, put on applicant s damaged/lost passport . (iii) Did applicant avail transfer of residence, foreign travel scheme facility on lost/damaged passport ? If so, details please. 23. Is applicant registered with Indian Mission/Post? If not, is he a member of any Indian Organization? DECLARATION I owe allegiance to the sovereignty and integrity of India , and 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, I undertake to be entirely responsible for expenses of my son/daughter/ward.

6 Signature or Thumb Impression of applicant (Left hand of male and right hand for female) Place: Kuwait Date: Page 3 of 8 Signatures or Thumb Impression of the applicant within the space given below: passport size photograph 35mm X 45mm , Embassy of India , Kuwait Box: 1450, Safat 13015 Tel: 2530600/612/613/614 Fax: 2573910 Website: Page 4 of 8 :1450 13015 :2530600 /612 /613 /614 :2573910 AFFIDAVIT I, ---------------------------------------- -- S/o, D/o, W/o ----------------------------------- r/o (Address in India ) ---------------------------------------- ---------------------------------------- -------------------------- do solemnly declare that I am a citizen of India and have not sought or obtained any other nationality.

7 I was born at ------------------------------ on --------------------- (date of birth) take oath and solemnly declare / affirm that the particulars furnished by me in the application for passport are correct and that I have not concealed misrepresented any facts in it. I solemnly declare that there are no criminal or civil cases pending against me in any court of law in India . Signature: Date: ------------ Civil ID Number: ------------------------ Address in Kuwait : ---------------------------------------- ------------------------ Page 5 of 8 ADDITIONAL DETAILS TO BE FURNISHED ALONG WITH APPLICATION FOR ISSUE OF DUPLICATE passport IN LIEU OF LOST / DAMAGED passport NAME : ALIASES, IF ANY : NAME OF FATHER/HUSBAND : DATE & PLACE OF BIRTH : NATIONALITY : OCCUPATION : PRESENT ADDRESS : PERMANENT ADDRESS IN India .

8 DETAILS OF THE LOST / DAMAGED passport : passport NO. : DATE & PLACE OF ISSUE : DATE OF EXPIRY : VISIBLE DISTINGUISHING MARK : EXACT DATE OF LOSS OF PASSSPORT : EXACT DATE OF LODGING LOSS REPORT WITH THE LOCAL POLICE : EXACT DATE FROM WHICH THE APPLICANT HAS BEEN RESIDNG ABROAD : PERIOD OF STAY ABROAD : SIGNATURE OF THE APPLICANT Page 6 of 8 AFFIDAVIT FROM WITNESS I, _____S/o, D/o, W/o _____ holder of Indian passport No. _____dated _____ Issued at _____ do solemnly affirm that Mr. / Mrs. / Ms. _____ is personally known to me. He / She is a citizen of India and has applied for duplicate passport as his / her passport is lost / stolen.

9 I solemnly declare that particulars furnished by him / her in passport application are correct. I solemnly declare that there are no criminal or civil cases pending against me in any court of law in India . Signature: Civil ID Number: _____ Address in Kuwait : _____ Telephone: Page 7 of 8 AFFIDAVIT FROM WITNESS I, _____S/o, D/o, W/o _____ holder of Indian passport dated _____ Issued at _____do solemnly affirm that Mr. / Mrs. / Ms. _____ is personally known to me. He / She is a citizen of India and has applied for duplicate passport as his / her passport is lost / stolen. I solemnly declare that particulars furnished by him / her in passport application are correct.

10 I solemnly declare that there are no criminal or civil cases pending against me in any court of law in India . Signature: Civil ID Number: _____ Address in Kuwait : _____ Telephone: Page 8 of 8 No Requirements for New passport in lieu of Damaged passport