Form No.


SIZE 51X51 mm
(For the issue of an ordinary international passport Fresh/After 10 years/and for Duplicate in lieu of lost/damaged passport)


Applicant must past one photograph above With half the signature on the photo and Half on application

Specimen Signature

(Please delete inapplicable) Payment of Fee (to be filled by applicant)

Amount paid Php __________________________by________________________________________Mode of payment


Surname Given Name: Aliases, if any: Has applicant ever changed his/her name ? If so, give previous name in full: Date of Birth: Place & Country of Birth Colour of Eyes Hair Sex :MALE/FEMALE


Height (Cms)

Father’s Name: Mother’s name: Country of his birth: Country of her birth: Nationality of father at the time of applicant’s birth ________________________________________ Nationality of mother at the time of applicant’s birth _______________________________________ _________________________________ 5. In country of domicile ________________________________________________________________________________ ____________________________________________________________________________________________________ 4. Telephone: 13. identity card if any. No. When did applicant first leave India How long has applicant continuously resided abroad? When was he/she in India last: 12.Permanent address: In India ____________________________________________________________________________________________ __________________________________________________________________________________________________ 3. Name ____________________________________ Address _________________________________________________________ Present passport/nationality. Place of Issue Date & Place of Issue 8. Particulars of person to be intimated in the event of death or accident: 7. . 10. Married ( )/Unmarried ( ) Spouse’s Name & Nationality 6. Present Emigration status (with documentary evidence): (ECR/ECNR) Occupation and business address 14. Date of Issue: 9. Local car driving License No. Educational qualification (in order to determine emigration status) 11.

please give details: Was applicant ever refused an Indian passport? (Yes/No) Was applicant's passport ever impounded/revoked ? If so. details please. is he a member of any Indian Organization? 24. details please Is applicant registered with Indian Mission/Post? If not. if any. 17. (ii) Did applicant avail transfer of residence. Is applicant in Govt. 25. put in applicant's damaged/lost passport. if so. of India? If so please give details : 22. ii. please give details and enclose 'No objection certificate' from you employer in original. to be deleted: Name Place & Date of Birth Sex (M/F) Note: Separate passport will be issued to children of all ages. please give details : 21. 16. No. foreign travel scheme facility on lost/damaged passport ? If so. (i) Are any criminal proceedings pending against the applicant in any court in India? If so. Did applicant ever possess any other nationality or travel document of any other country. 19. if any. Particulars of children. (Yes/No) Name and address of two relatives/friends in The Philippines / India: i. of lost/damaged passport: Place of issue: Date of issue: Valid Until (i) Briefly state circumstances of loss/theft/damage of passport on a plain paper and attach copy of report lodged with local 23. 18. However. 20. (ii) Has applicant ever been repatriated from abroad to India at the expenses of the Govt. police in case of loss/theft. (ii) Give details of restriction. if citizen of India by Birth/Descent/Naturalization/Registration. Service/Public Undertaking Service/Statutory Bodies Services of India? If so.15. children below 15 years of age will be given a 5-year maximum validity passport. Please mention. .

__________________________________________ Of whom we are the Parents/Guardian.I. Mother's passport No. 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. The information given by me is true and I am solely responsible for its accuracy. surrendered or been deprived of citizenship of India.OR…………………………………. …………………………………………………………AND……………………………………………………. I have not lost. I am aware that it is an offence under the Passports Act. It is also certified that the name of the child mentioned is not included in Passport of either parent. _____________________________________Sh. & Date Declaration of Parents or Guardian if passport is for minor: (To be signed by both parents or Guardian): We affirm that the particulars given above are in respect of (Name) ____________________________________________ 28 Son/daughter of Smt.I. Date & Place of Issue Date & Place of Issue If parents have applied for a passport. In case of Minor: Father's passport No. Signature/Thumb Impression of applicant (Left hand T. 1967 to furnish any false information or to suppress any material information with a view to obtaining Passport or any other travel document.I if male and right hand T. We undertake the entire responsibility for his/her expenses.I. if female) Date ________________ Place _________________ 27.I. Specimen signature or T..26. if female) 29. Mother Father Guardian Name & Signature/T. of applicant within the space given below: FOR OFFICE USE . please give File No. of both the parents/Guardian (Left hand T. DECLARATION: I owe allegiance to the sovereignty.I if male and right hand T. unity and integrity of India and have not voluntarily acquitted the citizenship or travel document of another country. We solemnly declare that he/she has not lost.

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