-

.1< .
,ANNEXURE'0'
SPECIMEN AFFIDAVIT/DECLARATION BY APPLICANT'S PARENT(S)
OR GUARDIAN FOR ISSUE OF PASSPORT TO MINOR

I/we/' -- ~ __ ~.~i~,T_~

Andsmt --~--~(~( ~,, __ ~,.

Resident of ---, .••..•

hereby affirm that the particulars given below are of

(name of the child) -_

son/daughter of Shri .......; _

andSmt ---------------------------------- ----_~--~

of whom I/we am/are the parents jguardian.

Particulars of minor child

Name: --_-------- __ --~

Date of birth: .....,..._

Place of birth: _

2 The minor child mentioned above is a citizen of India.

3. I/We undertake the entire responsibility for his/her expenses.
4. 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.
5. It is also certified that I/we am/are holding /not holding valid India passport(s).

Place: MUMBAI! THANE

Date: ---------

Signature of father Signature of mother Signature of legal guardlanls)

Passport No.. --'; or Passport No, - __ --'; or Passport No.,~-- ----'; qr

Aadhaar Card No. -'; or Aadhaar Card No. ~; or Aadhaar Card No.__ -,---.-,...,.....•...•
: or

Voter ID Card No, -' Voter ID Card No, ~ Voter ID Card No,-.-..___-----