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one photo here

Embassy of India
Muscat
Tel: 24684500
Website: http:// www.indemb-oman.org
E-mail : cons.muscat@mea.gov.in
indiamct@omantel.net.om

APPLICATION FOR INDIAN PASSPORT AND MISCELLANEOUS SERVICES

1 RE-ISSUE OF PASSPORT: DUE TO:
A) EXPIRY OF 5 / 10 YEARS VALIDITY For official use only
B) CHANGE OF NAME/SIGNATURE
C) CHANGE IN APPEARANCE PASTE
D) EXHAUSTION OF PAGES IN THE
EXISTING PASSPORT A
E) ANY CHANGE IN THE LAMINATION PHOTO HERE
PORTION OF THE EXISTING PASSPORT Plane white back ground
2 DUPLICATE PASSPORT IN LIEU OF and dress in dark colour
LOST / STOLEN, (4.5X3.5 cm without
(PLEASE SUBMIT DOCUMENTS AS PER LIST border)
ATTACHED) don't sign the photo
3 DUPLICATE PASSPORT IN LIEU OF DAMAGED
PASSPORT
4 PASSPORT FOR CHILDREN BORN IN OMAN
(PLEASE SUBMIT DOCUMENTS AS PER LIST
ATTACHED)
5 RENEWAL OF SHORT VALIDITY PASSPORT
6 MISCELLANEOUS SERVICE Signature inside the box with
(PLEASE WRITE DETAILS IN COLUMN 23) Black Ink Ball pen

Applicant should come personally or the documents should have been verified by the Honorary Consular Agent
NOTE authorized by the Embassy. FILL IN USING BLOCK LETTERS WITH BLUE/ BLACK INK ONLY AND ALL THE
COLUMNS SHOULD BE FILLED PROPERLY OTHER WISE THE APPLICATION MIGHT BE REJECTED.
1. FULL NAME (EXPANDED INITIALS)

___ShamsGoolrez_____________________ _________N/A________________
_______________________
(SURNAME NAME) (GIVEN NAME) (MIDDLE NAME)
2. IF YOU HAVE EVER CHANGED YOUR NAME, WRITE YOUR PREVIOUS NAME: N/A

3. PLACE OF BIRTH 4. COUNTRY OF BIRTH

5. DATE OF BIRTH 6. SEX

(DD) / (/MM) / (YYYY)

7. FULL NAME OF FATHER NATIONALITY

8. FULL NAME OF MOTHER NATIONALITY

9. FULL NAME OF SPOUSE

NATIONALITY
(HUSBAND/WIFE)

10. PROFESSION Company/Office Designation

11. PRESENT ADDRESS IN

OMAN

TEL. NO. GSM. NO. E-MAIL

12. PERMANENT ADDRESS
IN INDIA
13. PRESENT PASSPORT NO.

I) DATE OF ISSUE II) PLACE OF ISSUE III) DATE OF EXPIRY

14. PARTICULARS OF A PERSON TO BE INTIMATED IN THE EVENT OF DEATH OR ACCIDENT:

a.) NAME b.) RELATIONSHIP c.) Tel.

d.) ADDRESS

15.HEIGHT 16. COLOUR OF EYES 17.COLOUR

OF
HAIR
18. VISIBLE DISTINGUISHING MARKS, IF ANY

19. ARE YOU A CITIZEN OF INDIA BY i) Birth ii) Descent iii) Naturalization / Registration

20. DID YOU EVER POSSESS ANY OTHER NATIONALITY OR TRAVEL DOCUMENT OF ANY OTHER Yes
COUNTRY? If so, please give details
No
21. IF THIS APPLICATION IS FOR DUPLICATE PASSPORT, WAS THE PREVIOUS PASSPORT LOST DAMAGED NOT APPLICABLE
(If damaged, please attach damaged passport & if lost, then attach the requisite documents as per list)

22. a.) WERE YOU EVER REFUSED A PASSPORT?

Yes No
b.) WAS YOUR PASSPORT EVER ORDERED TO BE IMPOUNDED OR REVOKED?
Yes No
IF ANSWER TO ANY OF THESE QUESTIONS IS “YES,” PLEASE ENCLOSE A COPY OF THE OFFICIAL COMMUNICATION RECEIVED BY YOU
AND GIVE OTHER DETAILS.
23. DETAILS OF THE SERVICE REQUIRED: (IF APPLYING FOR MISC. SERVICE)
1) Police clearance certificate (attach 4 photos, passport & its copy)
2) NOC for acquiring omani nationality (attach all passports & its copies)
3) NRI certificate (attach passport with copy, along with all visa pages)
4) Addition of husband/wife name (Attach original Marriage Certificate (returnable)
issued by Registrar of Marriages and a photocopy thereof), and copy of spouse's passport.
5) Deletion of husband/wife name (Attach original Divorce Decree
issued by a Court in India (returnable) and a photocopy thereof.
6) Change of Address (Attach original (returnable) and a photocopy of Election
Card/current water bill/electricity bill/telephone bill/bank statement/income tax
return starhped by IT Deptt (all documents should show applicant's name)
7) ECNR stamp (Attach 3 yrs. visa pages or 10th class Certificate). For children below
18 years no documents are required.
8) Any other Service :-

SPECIMEN SIGNATURE OF APPLICANT ONLY

(THUMB IMPRESSION (T.I), IN CASE OF AN INFANT)
Left hand T.I. if male and right hand T.I. if female

SELF DECLARATION :

I OWE ALLEGIANCE TO THE SOVEREIGNTY & INTEGRITY OF INDIA AND HAVE NOT VOLUNTARILY ACQUIRED THE CITIZENSHIP OR
TRAVEL DOCUMENT OF ANY OTHER COUNTRY. I HAVE NOT LOST, SURRENDERED OR BEEN DEPRIVED OF CITIZENSHIP OF INDIA.

THE INFORMATION GIVEN BY ME IN THIS FORM AND ENCLOSURES IS TRUE AND I AM SOLELY RESPONSIBLE FOR ITS ACCURACY. I AM
AWARE THAT IT IS AN OFFENCE UNDER PASSPORT ACT, 1967 TO FURNISH ANY FALSE INFORMATION OR TO SUPPRESS ANY MATERIAL
INFORMATION WITH A VIEW TO OBTAINING PASSPORT OR ANY OTHER TRAVEL DOCUMENT.

I FURTHER DECLARE THAT I HAVE NO OTHER PASSPORT / TRAVEL DOCUMENT.

________________________________________
(Signature or thumb impression of applicant)
Declaration by Parents/Legal Guardian in case of Minor:

1) Information given above in respect of _____________________________ of whom I am the parent / legal guardian is true.
2) I undertake to be entirely responsible for his / her expenses.
3) I solemnly declare that he / she has not lost, surrendered or been deprived of his/her citizenship of India.
4) I hereby declare that ________________________________ born in Oman has not applied for or acquired Omani/ any other
citizenship/travel document. Should I approach the Omani or any other authorities for such a travel document, I undertake to inform the
Embassy of India, Muscat immediately so that Indian travel document may be withdrawn.
Place: _________________________

Date: __________________________ __________________________________________

Signature of both the Parents /Legal guardian

Copies of passports of both parents to be enclosed.