(Zo be executed on appropriate non-judicial stamp paper and attested by a Notary
1
Public)
1, (aame),____ Anand Kumar Mourya Employee No. _103410
Son/Daughter of Shiva Nand Ram residing at
NH -2.C-2, NTPC COLONY , VINDHYANAGAR, SINGRA\
(M.P)- 486885
Date of Birth___03 July 1985 and presently employed at NTPC Ltd. at
its Corporate Office located at New Delhi intend to apply for Indian Passport
for my dependant family member ‘Aashna Mourya 1 do
hereby solemnly affirm and state as follows:
‘That the aforesaid dependant family member is continuously residing at the
above mentioned address with me from... 08 June 2017,
That the aforesaid dependant family member is a citizen of India by
birth /descent/registration/naturalization and that he/she has neither acquired
the citizenship of another country nor has surrentéted or been
terminated /deprived of citizenship of India.
JAGATLAL SHAH
Adve
try
wa eR Snant OP)one
ai
hi