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Form 2

Embassy of India Riyadh Application for Miscellaneous Services


1. 2. 3. 4. Name : MOHAMMED ABDUL KABEER Fathers/Husbands Name : MOHAMMED AZIZ HUSSAIN Date of Birth : 25/12/1982 Place of Birth : HYDERABAD

Please affix one Photo

Permanent Address : House No. 18-7-198/A/214, Murad Mahal, Talab Katta, Hyderabad, Andhara Pradesh, India Tel No. 00919885173128

5.

Present Address in KSA : Al-Wazaraat (HARA), Taj Ad Din Al Malki Street, Opp Lane Riyadh Bank ATM, Riyadh, KSA. Tel No. 0559905423

6. 7. 8.

New Name : (if application is for change of name) New Address : (if application is for change of address) Details of current passport : Passport No. : F6767075 Place of Issue : Hyderabad Details of previous passport : Passport No. : Place of Issue :

Date of Issue : 20/02/2006 Valid Until : 19/02/2016 Date of Issue : Valid Until :

9.

Service Required : Please tick and strike out the others. a. Renewal upto full validity b. ECNR Stamp c. Inclusion of spouses name: NUZHAT SULTANA d. Change of Name/Maiden Name e. Police Clearance Certificate (for : please write name of country) f. Change of Address g. Any other Please specify :

[Photo is to be affixed for (a) (if passport is not issued from Riyadh, (e) and (f)]

____________________________________________ Signature of Applicant For Official Use Only To : PASSEM/HICOMIND/INDEMBASSY/CONGENDIA No. RIY/C/

Please confirm/verify the passport particulars/new address mentioned above in order to enable us to render the requested service.

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