ANNEXURE'D'

spEclMEN DECLARATTON By AppLtcANT',S PARENT(S) OR GUARDIAN FOR ISSUE OF

PASSPORT TO MINOR

(On plain paper)

l/we nt.U .,...1........n11i.ax.a',cn' - }rk r. *..S^J..i..o.........

hereby affirm that the
particulars given below are of
hter of Shri and
(name of the ch
Smt. .... of whom l/we am/are the parents lguardian.

1, Particulars of minor child

Name: Swava. + l,Q^'ya

Date of birth : 2t ffN; e.
Place of birth : }{4*ta ,'
2. The minor child mentioned above is a citizen of lndia.

3. lAffe undertake the entire responsibility for his/her expenses.

4. l/we solemnly declare that he /she has not lost, surrendered or been deprived of his/her citizenship
of
lndia and that the information given in respect of him/her in this application is true.

5. tt is also certified that l/we am/are holding lnot holding valid lndia passport(s)'

Place:
Ir Date: zs o2- >o>la
l\rl.f^.ba I

'+;i.

,qff_ Signature of mother

Signature of father

Passport No. .T-s.-t" 37o or passport uo , .Gefid .?.-6.5.:,!t-:--7-..,.,,

Aadhaar Card No.: -.... or Aadhaar Card No...... ...'.'....".'.... or

Voter lD Card No.:.... Voter lD Card No.:

Signature of legal guardian(s)

Passport No.: .......... ........'-......... or

Aadhaar CardNo.: or

Voter lD Card No.