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Form No. EAP-I External
EMBASSY OF INDIA, ABU DHABI, CONSULTATE GENERAL OF INDIA, DUBAI
Fee Details - Passport Booklet of 36 pages Dhs.285/-. For Minor below 18 years: Dhs.190/-.
51 mm x 51 mm
Amount of fee (paid in cash): (UAE Dhs.) ___________ (to be filled in by the applicant)
(a) Surname ____AJMANI_____________________________________________________
(b) Given Name__YASH______________________________________________________
(c)Aliases, if any_____________________________________________________________
(c) Has applicant ever changed his/her name? If so, give previous name in full_____________
Maiden name, if applicant is a married woman __________________________________
(e) Sex (Tick mark) : Male Female
Date of birth DD 31 MM 10 YYYY 2016
Place & country of birth ___________DUBAI, UNITED ARAB EMIRATES _______________
Height___________________ Color of eyes_____BLACK____________________________ Color of Hair_____BLACK ____________________________________________________
Visible distinguishing marks, if any _____________________________________________________________________
Permanent Address: (Please attach documentary evidence of change, if any 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)
(a) In India _____________________________________________________________
(b) Address is UAE ______________________________________________________ ______________________________________________________
4. Name of Father ______________________ Country of his birth _____________ Name of Mother _____________________ Country of her birth _____________ Nationality of father at the time of applicant’s birth_______________________
Nationality of mother at the time of applicant’s birth______________________
Married Unmarried (Tick mark)
Name & Nationality of Husband/Wife___________________________________
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
Present Passport No._______________
Date & Place of issue _________________________________________________
9. Local Car Driving Licence No. __________________________________________ Date & Place of issue ___________________________________________________
Local Labour Card No. _________________________________________________
Date & Place of issue __________________________________________________
Local Health Card No. _________________________________________________
Any other Identity Card issued locally & held by the applicant
No. _____________ Date of issue ______________ Place of issue______________
Authority issuing it____________________________________________________
Educational Qualification _____________________________________________
When did applicant first leave India ____________________________________
When was he/she in India last _________________________________________
How long has applicant continuously resided abroad? ____________________
Present Emigration Status ( ECR or ECNR ) ______________________________
(With documentary evidence)(Attach photocopy of ECR/ECNR page of passport)
Profession and business address* _______________________________________________________________________________________________________________________________________________________________________________________________________________
(*Please give complete physical location and not just the P.O. Box no. Please indicate Flat/Apartment/Villa no., no. /Name of the Building, No/Name of the Street, Area/Zone important landmarks to help identify the building etc. and telephone/telex/fax no. and e-mail address, if any)
Please mention, if citizen of India by birth/descent/naturalization/Registration
Did applicant ever possess any other nationality or travel document of any other country? If so, please give details?
Was applicant ever refused an Indian Passport? (Yes/No)
Was applicant’s passport ever impounded/revoked? If so, details please (Yes/No)
Name and address of two relatives/friends, one in India and one in UAE
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 __________________________________________________
(i) Are any criminal proceedings pending against applicant in any court in India? If so, please give details _________________________________________
Has applicant ever been repatriated from abroad to India at the expenses of the Govt. of India? If so, details please _____________________________
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
Give details of restriction, if any, imposed on applicant’s damaged/lost passport
Did applicant avail himself/herself of transfer of residence, foreign travel scheme or any other facility like gold/silver import on lost/damaged passport? If so, details please _______________________________________
Is applicant registered with this Embassy or our Consulate General in Dubai? If not, is he a member of any Indian Organisation/Associations?
Particulars of children, if any, to be deleted from the passport:
Name Place & Date of birth Sex (M/F)
__________________________ _______________________ _____
I solemnly affirm that:
I owe allegiance to the sovereignty, unity and integrity of India and have not voluntarily acquired the citizenship or travel document of another country. I have not lost, surrendered or been deprived of citizenship of India.
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.
I undertake the entire responsibility for expenses of my son/daughter/ward.
Signature/thumb impression of applicant or his legal guardian (Left hand T.I if male and right hand T.I if female)
27. In case of minors, following passport particulars of both parents must be given:
Mother Father (a) Passport No.: _________________ _________________ (b) Date of issue: _________________ _________________ (c) Place of issue: _________________ _________________ (d) If parents have applied for a passport, please give file No. & date _________________ _________________
28. Declaration of parents or guardian, if the passport is of minor: (to be signed by both parents or guardian)
I/We affirm that the particulars given above are in respect of ____(name)_____________ son/daughter of Smt. ______________________ Shri _________________________ of whom we are the Parents/Guardian. We undertake the entire responsibility for his/her expenses. We solemnly declare that he/she has not lost, surrendered or been deprived of his/her citizenship of India and that the information given in respect of him/her in this application is true. It is also certified that the name of the child mentioned is not included in passport of either parent.
…………………………. ………………………….. ………………………
Signature of Mother and Signature of Father or Signature of Guardian
Name & signature/thumb impression of both the parents/guardian (left hand T.I. if male and right hand T.I. if female)
Place ..………………………….. Date ..…………………………..
29. Specimen signature or thumb impression of applicant within the space given below:
Note: - Signature should be clear and it should be in the middle of the boxes.
FOR OFFICE USE
EMBASSY OF INDIA
TO BE FILLED UP BY APPLICANTS WHOSE PASSPORTS ARE ISSUED BY
OTHER PASSPORT ISSUING AUTHORITIES
1. Name: _______________________________________________________
S/O, D/O, W/O _________________________________________________
2. Date of Birth: ______________ Place of Birth: ______________________
3. Permanent Address: ___________________________________________
4. Address in U.A.E. with Tel. No. : ________________________________________
5. Passport No. ____________________ Date of Issue: _______________
Place of Issue: _______________ Valid until: _______________
6. Service Required: - (Please put tick mark)
(a) Re-issue of Passport in lieu of Final Validity expired Passport.
(b) Re-Issue of Passport due to change in appearance / Name
(c) Extension of Validity of Passport
(d) PCC / Change of Address
(Signature of the applicant)
FOR OFFICE USE ONLY
No. ABU / CONS /405 / Date: _______________
Forwarded to RPO / El/ HCI / CGI ______________________________ with the request to confirm the passport particulars and communicate your objection, if any, in rendering the required service.
He / She has been issued a Passport bearing No. _________________, on _______________ valid until _______________ by us under tatkal.
Affix one Passport size photo here
ave not voluntarily acquired the citizenship or travel document of another country. I have not lost, surrendered or been deprived of citizenship of India.
The information given above in respect of myself, my son/daughter/ward is correct an