51mm*51mm

(b) Address in UAE (Complete address, No P.O.Box No.) 4. Name of Father Country of his birth Name of Mother Country of her birth Nationality of father at the time of applicant birth s Nationality of mother at the time of applicant birth s 5. Married Unmarried (Tick mark)

6. Name & Nationality of Husband/Wife 7. (i) Name of applicant eldest son or daughter (First child) s (ii) Name of applicant eldest brother or sister s (iii) Particulars of person to be intimated in the event of death or accident IN UAE IN INDIA Name: Address: 8. 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. Date & Place of issue Any other Identity Card issued locally & held by the applicant No. Date of issue Place of issue Authority issuing it 10. Educational Qualification 11. When did applicant first leave India When was he/she in India last 12. How long has applicant continuously resided abroad?

(3)

13. Present Emigration Status ( ECR or ECNR)______________________________ (With documentary evidence)(Attach photocopy of ECR/ECNR page of passport) 14. Profession and business address* _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Telephone/Fax/E-Mail_______________________________________________ (*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 and important landmarks to help identify the building etc. and telephone/fax no. and e-mail address, if any) 15. Please mention, if citizen of India by birth/descent/naturalization/Registration ____________________________________________________________________ 16. Did applicant ever posses any other nationality or travel document of any other other country? If so, please give details? ____________________________________________________________________ 17. Was applicant ever refused an Indian Passport?(Yes/No) 18. Was applicant passport ever impounded/revoked? If so, details please s (Yes/No) 19. Name and address of two releatives/friends, one in India and one in UAE 1. _______________________________________________________________ _________________________________________________________________ 2. _______________________________________________________________ _________________________________________________________________ _________________________________________________________________ 20. Is applicant in Indian Govt. Service/working for an Indian Public Sector Undertaking/Statutory Body? If so, please give details and enclose o Objection Certificatefrom your N employer in original____________________________________________________

(4)

Is applicant registered with Embassy of India, Abu Dhabi or Consulate General of India Dubai? If not, is he a member of any Indian Organisation/Associations?

(5)

I/We affirm that the particulars given above are in respect of _____________________ son/daughter of Smt. __________________and Shri ________________________, of whom I am/we are the Parents/Guardian. I/We undertake the entire responsibility for his/her expenses. I/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)

(6)

(7)