HIGH COMMISSION OF INDIA PHOTO OF Te APPLICANT 31 Grange Road, India House, Singapore 239702 ‘Telephone: 65-87376777 Fax: 65-67326909 | veers Website: www.embassyofindia.com SHAR RERES HOR SEND | artacn 2necent | | "Gexsecn | PHOTOGRAPH ‘eesti ie Foe PASSPORT APPLICATION FORM Peete tm, acy rpc lasne en, PLEASE FILLIN BLOCK LETTERS. ‘SURNAME : (incase Given Name exceeds 0 charactors pat ofthe gven name may be ested wth Sumame) [IT I l I I l GIVEN NAME : SEX DATE OF BIRTH (DD-MM. Wiel] Fomat| LL d+ PLAGE OF BIRTH FATHER'S NAME / LEGAL GUARDIAN'S NAME | NAME OF MOTHER NAME OF HUSBAND / WIFE PERMANENT ADDRESS (IN INDIA) CURRENT PASSPORT DETAILS (F ANY) 1. CURRENT PASSPORT NUMBER 5, PLACE OF ISSUE [ I l FOR OFFICE USE ONLY FILE NUMBER PASSPORT NUMBER DATE OF ISSUE4. Full Name: ‘Rane Ge Sanaray 2. Aliases, it any 3. Hes appl nt ever changed hishher name? Ifo, give previous name in fl: 4, Height (crn) Colour of Eyes: Hair 5. Visible Distnguishing marks, i any: 6. Permanent Adress In india: Phones) 7. Present Adress: In Singapore: _ Phone(s) 8, Name of Father: 1 Country of his bit - Nationality offater at the time of appicant bit 8. Name of Mother 1 County of her bit Nationality of Mother atthe time of applicants bith; 10. Maried/ Unmarried: ‘1. Name and Netionalty of Spouse: 42. Educational Qualification: (inorder to determine emigration satus) 13, When cid applicant frst leave India \When was hefshe in India last: +14, How long has applicant coninuousy resided abroad? 45, Profession and business adress: Phone(s) 16, Please mention, if citizen of India by bith / descent (naturalization f Registration 17. Did applicant ever posses any other nationalty or revel document of any other county, ifso, please give deta: 18, Was applicant ever relused an Indian Passport? Yes/No 419, Was applicants passport ever impounded! revoked? Ifso, please givedetais: Yes/No 25. Names and fll addresses of two relativesiionds: (In ingia: Phone(s) (1) In Singapoce: Phone(s)26. Are any criminal proceedings pending against applicant in any cour in India? Iso, please give details: 27. Hes applicant ever been repatriated from abroad to nia atthe expenses of the Government of india? Iso, please give details: 28. No. of lost damaged passport: Pave of Issue: Date of issue: Date of Expiry 23. Brief state circumstances of oss /theft/ damage of passport on a plain paper and attach copy of report lodged with local police in case ofoss thet. 30. Give details ofrestricion, if any, put on appkcant's damaged lost passport. 31, Did applicant availed transfer of residence, foreign travel scheme fect on lost/ damage passport? If so, please give deta DECLARATION | solemnly afin that, lowe allegiance othe sovereignty and integrity of india, and © Information given above in respect of mysel, my son! daughter! ward is correct and nothing has been concealed and | am aware that tis an offence unde the Passport Act 1967 to knowingly furnish false information or suppress ‘mato‘alinformaton, which atract pena and other punishments under the acts and, (i) undertake to be entirely responsible for expenses of my sor! daughterivard ‘Signature of te Applicant ‘OR For Minor chid tumb impression (Cefthand of male and ght hand of female) Date: race: Specimen signature ofthe applicant within the space given below: [For Mino cid thumb Impression (Lefthand of male and righthand of female)INSTRUCTIONS i) Please refer www.embassyofindia.com for detailed information on requirement / application forms and requisite fee for passport application. ii) Consular Timings Submission of Applications: 9.15 am to 11.30 am Collection of documents: 4.15 pm to 8.15 pm Please stick to the submission and collections timings and date of collection ii) Applicant needs to submit applications personally and also collect documents personally. iii) Please complete the application form and sign before you obtain a queue number. ‘Queue numbers are issued only up to 11.30. am. iv) Please submit applications for passport related services at counter number 9 or 10. v) Payment is to be made at the time of Submission Of Application and in Cash only. Fee Schedule: Fresh Passport S$ 80/- (38 pages) Jumbo Passport : S$ 100/ - (60 pages) Issued only on availability of stock) Child Passport S$ 50/- Duplicate Passport —_: S$ 250/- (36 pages) Duplicate Passport _: S$ 270/ - (BOpages) (Issued only on availability of stock) Emergency Certificate :S$ 10/- Fax Form Charges: S$_20/- (to be paid only if current passports not issued in vi) Please attach two latest colour photographs. vii) Please submit original and copy of Marriage Certificate in case Husband / Wife name is to be added in your passport. vill) Please submit any proof if change of address in the passport is lo be made. ix) Please inform about the valid visas (if any) in your current passport at ime of submission of application forms to enable us to give necessary endorsements. Please check with the concerned Embassies regarding procedures for transfer of visa. x) Please bring the original receipt at time of collection of documents. xi) Please check your documents before you leave the counter.