Print Form
No. : EAPX-II-96
E.A. (P)-2 EXTERNAL
FREE OF CHARGE
Sl.
APPLICATION FORM FOR MISCELLANEOUS SERVICES ON INDIAN PASSPORTS
(For use in Indian Mission/Post)
(a) PCC (b) Any Other Service (Specify)
(Please delete Inapplicable)
Please staple one
Photograph of size of
2 x 2 inch
(51 mm x 51 mm) &
enclose three for
additional booklet
Payment of Fee (to be filled by applicant)
Amount Paid __________________________ by ________________________________ (Mode of Payment)
For Delivery by mail $/£___________ extra to be paid as postal charges for each passport
____________________
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1. Full Name : ________________________________________________________________________
2. Applicant’s Car Driving Licence No. : ____________________
Date & Place of Issue :_______________________________________
3. Residential Address :
(i) In India (ii) In country of domicile
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Tel. : ________________________________ Tel. : ___________________________________
4. Profession and business address _______________________________________________________
Tel. : _____________________________________________________________________________
5. Is applicant registered with the Indian Mission / Post? If not, is he a member of any Indian
Organization? Give details.
6. (i) Name of Father : ____________________________________________
(ii) Name of Mother : ____________________________________________
(iii) Name of Spouse & Nationality: _________________________________
7. Current Passport No.: ________________________ Valid until: ____________________________
Place of its Issue: ___________________________ Date of Issue: _________________________
8. Particulars of children to be included / deleted :
Name Place & Date of Birth Sex (M/F)
____________________________ ______________________________________ ___________
____________________________ ______________________________________ ___________
____________________________ ______________________________________ ___________
Note: In case a fresh inclusion of name(s), enclose the given below:-
(i) Birth certificate(s) bearing names of both parents
(ii) Marriage certificate of parents.
(iii) Passports of both parents.
Children below fifteen years of age can either apply for inclusion in their parent’s, generally mother’s
passport, or apply for separate passports. Children above fifteen years must apply for separate passports.
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9. DECLARATION :
I solemnly affirm that:
(i) I owe allegiance to the sovereignty and integrity of India ;
(ii) Information given above is correct and nothing has been concealed and I am aware that it is an
offence under the Passport Act 1967 to knowingly furnish false information or suppress material
information ; and
(iii) I undertake to be entirely responsible for expenses of my son / daughter / ward.
__________________________________________
Signature or T.I of applicant or his legal Guardian
(Left hand thumb impression of Male & right hand
thumb impression of female)
Place: ____________________ Date: ____________________
10. Two specimen signatures or thumb impressions required for service(s) within the space given
below.
________________________________________________________________________________________
FOR OFFICE USE
