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Indian Embassy Paris Service Form

The document is an application form for miscellaneous services for Indian nationals residing in France, requiring personal information such as name, addresses, and passport details. It includes a request for various certificates like Police Clearance and Birth Certificate, along with an affirmation of allegiance to India and the accuracy of the provided information. The applicant must sign and date the form to validate their claims and responsibilities.

Uploaded by

Dr-RohitAash Malik Tara Chand
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45 views1 page

Indian Embassy Paris Service Form

The document is an application form for miscellaneous services for Indian nationals residing in France, requiring personal information such as name, addresses, and passport details. It includes a request for various certificates like Police Clearance and Birth Certificate, along with an affirmation of allegiance to India and the accuracy of the provided information. The applicant must sign and date the form to validate their claims and responsibilities.

Uploaded by

Dr-RohitAash Malik Tara Chand
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Embassy of India

Paris

APPLICATION FOR MISCELLANEOUS SERVICE


(For Indian Nationals only)

1. Full Name (Expanded initials) ______________________________________________

2. Address in France ______________________________________________

______________________________________________

Tel. No./Email __________________________________

3. Address in India ______________________________________________

______________________________________________

Tel.No./Email ___________________________________

4. Date of Birth & Place of Birth ______________________________________________

5. Name of Father ______________________________________________

6. Name of Mother ______________________________________________

7. Name of Spouse & Nationality ______________________________________________

8. Current Passport no. _____________________Place of Issue ______________

Date of Issue_____________ Date of Expiry___________

Kindly issue me the following certificate/document :-

Police Clearance Certificate Birth Certificate


Certificate de Coutume
Certificate de Concordance
Life Certificate

I solemnly affirm that (i) I owe allegiance to the sovereignty and integrity of India; (ii) Information
given above in respect of myself, my son/daughter/ward is correct and nothing has been concealed.
I am aware that it is an offence under the Passport Act, 1967 to knowingly furnish false information,
which attract penal and other punishments under the Act; (iii) I undertake to be entirely responsible
for expenses of my son/daughter ward (iv) I have not lost, surrendered or been deprived of my
citizenship of India. I have not voluntarily acquired the citizenship of another country; (v) I am not
in possession of travel document issued by any other country, and (vi) I have neither applied for nor
been granted asylum/refugee status in France or any other country.

(Signature of the applicant)


Place:- _________________
Date :- _________________

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