SWORN AFFIDAVIT

(MISCELLANEOUS)

I, _____________________________________________________ aged _______ Years

________________ Post Box No. ______________________ holder of

residing in

Indian Passport No.

______________________ issued at ________________________________ on _________________

hereby make an oath and state as follows:

That I could not renew my passport in time due to _____________________________________

______________________________________________________________________________.
I solemnly declare that I am an Indian National.
I have not lost/surrendered or been deprived of my Indian Citizenship.
I owe allegiance to India and have not voluntarily acquired citizenship of any other country.
That this affidavit is true, that conceals nothing and no part of it is false.

_____________________________
(Signature)

Sworn at the Embassy of India, Abu Dhabi/Consulate General of India, Dubai, this day the ___________
________ 1999 by Mr/Mrs._____________________________________ who made his/her signature
before me at Abu Dhabi/Dubai. He/she has been identified by his/her passport No. ________________
issued at ________________________on _________________.
The Consulate General of India, Dubai take NO RESPONSIBILITY for the correctness of the above
statement.
No.SA/

/20

ENDORSEMENT

Date