APPLICATION FOR INDIAN PASSPORT

' * , . 0 CONSULATE GENERAL OF INDIA, JOHANNESBURG 2 3 4 6 RE(ISSUE OF )ASS)ORT DU)LICATE )ASS)ORT IN LIEU OF LOST, STOLEN OR DA+AGED )ASS)ORT ADDITIONAL BOO-LET CHANGE OF NA+E/SURNA+E E+ERGENC1 CERTIFICATE CHANGE IN A))EARANCE )ASS)ORT FOR CHILDREN BORN IN SOUTH AFRICA RENEWAL OF SHORT 5ALIDIT1 )ASS)ORTS +ISCELLANEOUS SER5ICE

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No.1, Eton Road Cnr. Jan Smuts Ave. & Eton Road Park Town 2193, Johannes ur! 2""" P.#. $o% &'"(
Website: www. Indiains !t"a#$i%a.% &

NOTE

This application can be used at the High Commission o India! "PERSONAL CHE#$ES%CREDIT CARDS ARE NOT ACCEPTED FOR PA&'ENT OF FEES( "FILL IN $SIN) *LOC+ LETTERS ,ITH *L$E% *LAC+ IN+ ONL&(

'. FULL NA+E (EXPANDED INITIALS) 777777777777777777777777 8GI5EN NA+E9 7777777777777777777777777 8+IDDLE NA+E9 7777777777777777777777777 8SURNA+E NA+E9

*. IF 1OU HA5E E5ER CHANGED 1OUR NA+E, WRITE 1OUR )RE5IOUS NA+E: ,. )LACE OF BIRTH 0. DATE OF BIRTH 8DD9 3. FULL NA+E OF FATHER 4. FULL NA+E OF +OTHER 6. )ROFESSION ';. HEIGHT ''. COLOUR OF E1ES '*. COLOUR OF HAIR / 8/++9 / 811119 NATIONALIT1 NATIONALIT1 .. COUNTR1 OF BIRTH 2. SE:

',. 5ISIBLE DISTINGUISHING +AR-S, IF AN1 '.. FULL NA+E OF S)OUSE '0. )RESENT ADDRESS IN SOUTH AFRICA TEL. NO. '2. )ER+ANENT ADDRESS IN INDIA '3. )ARTICULARS OF A )ERSON TO BE INTI+ATED IN THE E5ENT OF DEATH OR ACCIDENT : a.9 NA+E d.9 ADDRESS i9 Bi$t" '4. ARE 1OU A CITI>EN OF INDIA B1 ii9 Des%ent iii9 Nat!$a<i?ati n Re@ist$ati n b.9 Re<ati ns"i= %.9 Te<. +OB. NO. E( +AIL

'6. DID 1OU E5ER )OSSESS AN1 OTHER NATIONALIT1 OR TRA5EL DOCU+ENT OF AN1 OTHER COUNTR1A If so, please give details 1es N

*;. IS THIS A))LICATION FOR A )ASS)ORT FOR THE FIRST TI+E NEW )ASS)ORT IN RE)LACE+ENT OF AN E:)IRED )ASS)ORT DU)LICATE )ASS)ORTA LOST DA+AGED

*'. IF THIS A))LICATION IS FOR DU)LICATE )ASS)ORT, WAS THE )RE5IOUS )ASS)ORT (If damaged, please attach damaged passport) **. )RESENT )ASS)ORT NO. OR DA+AGED OR LOST )ASS)ORT NO. I9 DATE OF ISSUE II9 )LACE OF ISSUE

III9 DATE OF E:)IR1 1es 1es N N

*,. a.9 WERE 1OU E5ER REFUSED A )ASS)ORTA b.9 WAS 1OUR )ASS)ORT E5ER ORDERED TO BE I+)OUNDED OR RE5O-EDA

IF ANSWER TO AN1 OF THESE BUESTIONS IS C1ES,D )LEASE ENCLOSE A CO)1 OF THE OFFICIAL CO++UNICATION RECEI5ED B1 1OU AND GI5E OTHER DETAILS.

*.. HA5E 1OU E5ER A))LIED FOR AS1LU+ OR REFUGEE STATUS IN THE SOUTH AFRICAA IF 1ES, )LEASE ATTACH RELE5ANT DOCU+ENTS.

1es

*0. a.9 BRIEFL1 STATE CIRCU+STANCES OF LOSS/THEFT/DA+AGE OF )ASS)ORT AND ATTACH RE)ORT LODGED WITH LOCAL )OLICE IN CASE OF LOSS OF )ASS)ORT. (PLEASE ATTAC !"#$ EXPLANATI"N "N A SEPA$ATE S EET "% PAPE$)

b.9 DETAILS OF RESTRICTION, IF AN1, )UT ON A))LICANTES DA+AGED/LOST )ASS)ORT

*2. DETAILS OF THE SER5ICE REBUIRED: 8IF A))L1ING FOR +ISC. SER5ICE9

SPECI'EN SI)NAT$RE OF APPLICANT ONL& (THUMB IMPRESSION, IN CASE OF AN INFANT)

SELF DECLARATION I OWE ALLEGIANCE TO THE SO5EREIGNT1 F INTEGRIT1 OF INDIA AND HA5E NOT 5OLUNTARIL1 ACBUIRED THE CITI>ENSHI) OR TRA5EL DOCU+ENT OF AN1 OTHER COUNTR1. I HA5E NOT LOST, SURRENDERED OR BEEN DE)RI5ED OF CITI>ENSHI) OF INDIA. THE INFOR+ATION GI5EN B1 +E IN THIS FOR+ AND ENCLOSURES IS TRUE AND I A+ SOLEL1 RES)ONSIBLE FOR ACCURAC1. I A+ AWARE THAT IT IS AN OFFENCE UNDER )ASS)ORT ACT, '623 TO FURNISH AN1 FALSE INFOR+ATION OR TO SU))RESS AN1 +ATERIAL INFOR+ATION WITH A 5IEW TO OBTAINING )ASS)ORT OR AN1 OTHER TRA5EL DOCU+ENT. I FURTHER DECLARE THAT I HA5E NO OTHER )ASS)ORT / TRA5EL DOCU+ENT.

77777777777777777777777777777777777777777777 "Signatu.e o. thumb imp.ession o applicant(

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