ANNEXURE-‘D’

SPECIMEN DECLARATION BY APPLICANT’S PARENT(S) OR GUARDIAN FOR ISSUE OF

PASSPORT TO MINOR

(On plain paper)

I/we, BANGAR MAYUR MARUTI resident of PUNE hereby affirm that the particulars given below are of
KARTIK MAYUR BANGAR. (Name of the child), son/daughter of Shri .MAYUR MARUTI BANGAR.and
Smt .SHILPA MAYUR BANGAR of whom I/we am/are the parents /guardian.

Particulars of minor child

Name: KARTIK MAYUR BANGAR

Date of birth: 27-07-2018

Place of birth: BHOSARI (PIMPRI-CHINCHWAD) PUNE

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: PUNE

Date Signature of father Signature of mother

Passport No.H6564677 Passport No.L7018171

Aadhaar Card No.7986 7537 9829 Aadhaar Card No.8173 0060 4731

Voter ID card No: HMW3913639 Voter ID card No: HMW2430866