ANNEXURE L

SPECIMEN AFFIDAVIT FOR A PASSPORT IN LIEU OF LOST PASSPORT (This affidavit is to be executed on non-judicial stamp paper of minimum value in the presence of First Class Judicial Magistrate or Executive Magistrate/Notary Public on the following points) I Pritpal Singh S/o Shri ParamjIt Singh residing at H.No. 2066, Barara, Tehsil Barara Distt Ambala solemnly affirm as follows: 1. State that my passport F6140629 was lost in Barara distt Ambala dated 29/01/2014 and FIR was lodged at Barara Police Station and one passports were lost earlier. 2. Yes I travelled on the lost passport and port to UAE IN 11-11-2008 entry into India at 27-12-2011 3. State whether you availed of any TR concessions/FTs allowance and if so details thereofNA 4. State whether non-resident Indian and if resident abroad, the details of the residence as follows: S.No. Name of the Length of Page Nos. of Country residence Passport From.To bearing departure & arrival stamps 1. ABU-DHABI (UAE) 11-11-2008 TO 27-12-2011 7 & 22

5. State whether the Passport had any objection by the PIA and if so the details thereof. N/A 6. State whether you were deported at any time at the expense of the Government and if so was the expenditure incurred reimbursed to Government of India. I further affirm that I will take utmost care of my passport if issued and the Government will be at liberty to take any legal action under the Passports Act, 1967, if the lapse is repeated.

Date: ..

Deponent

Affirm before First Class Judicial Magistrate or Executive Magistrate/ Notary Public

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