ANNEXURE ‘D’

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

MINOR

We, Zaheer Khan Malik and Shahnaaz Malik, resident of 63A/126C Defence colony Agra, hereby affirm
that the particulars given below are of Zafeer Khan, son of Shri Zaheer Khan and Smt. Shahnaaz Malik
whom we are the parents.

Particulars of the minor child

Name: Zafeer Khan

Date of birth: 12-01-2004

Place of birth: Agra

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

3. We undertake the entire responsibility of his expenses.

4. We solemnly declare that he has not lost, surrendered or been deprived of citizenship of India and
that the information given in respect to him in this application is true.

5. it is also certified that we are holding/not holding valid India passport(s).

Place: Agra

Date:03/05/2019

Signature of father Signature of mother

Aadhar card number Aadhar card number
6169 0913 6651 7697 2263 5632