APPLICATION FOR INDIAN PASSPORT

1. FOR A NEW PASSPOR ORDINARY TYPE

2. DUPLICATE PASSPORT IN LIEU OF LOST, PASTE A
STOLEN OR DAMAGED PASSPORT PHOTO
EMBASSY OF INDIA
3. ADDITIONAL PAGES /BOOKLET 3.5 cmx3.5cm
Consular Wing
2536 Massachusetts Avenue, NW
Washington, DC 20008
4. CHANGE OF NAME/SURNAME
Tel: (202) 939-9838 /9806 5. EMERGENCY TRAVEL DOCUMENT
Fax: (202) 387-6946
http://www.indianembassy.org 6. CHANGE IN APPEARANCE
Note: This application can be used at the Embassy of India, Washington, DC or at any other Consulate General of India
(PERSONAL CHECKS/CREDIT CARDS ARE NOT ACCEPTED)
(Fill in using Block Letters with Blue/Black Ink Only)
(b) ALIASES, if any
1.(a) FULL NAME (Expanded initials)
( First/Given Name) (Middle Name) (lLast/Sur Name)
(c) HAVE YOU EVER CHANGED YOUR NAME? (d) MAIDEN NAME, in case applicant
is a married woman
Yes No
If yes, please write your name in full
2. PLACE OF BIRTH 3. COUNTRY OF BIRTH 4. DATE OF
BIRTH
(Day) / (Month) / (Year )

5. SEX 6. COLOR OF EYES 7. COLOR OF HAIR 8. HEIGHT

9. VISIBLE DISTINGUISHING MARKS, if any 10. MARITAL STATUS

11. PROFESSION

12. BUSINESS/OFFICE ADDRESS: TEL NO.

13. (a) FULL NAME OF FATHER NATIONALITY COUNTRY OF HIS BIRTH

(b) FULL NAME OF MOTHER NATIONALITY COUNTRY OF HER BIRTH

(c) NATIONALITY OF FATHER AT THE TIME OF APPLICANT’S BIRTH (d) NATIONALITY OF MOTHER AT THE TIME OF APPLICANT’S BIRTH

14. FULL NAME OF HUSBAND / WIFE NATIONALITY TEL. NO.

15. W HEN DID APPLICANT FIRST LEAVE INDIA? 16 WHEN WAS HE/SHE IN INDIA LAST? 17 HOW LONG HAS APPLICANT CONTINUOUSLY RESIDED
ABROAD?

18
. PRESENT IMMIGRATION STATUS
*ECR / ENCR**_____________ (Please attach documentary evidence, such as copy of degree/green card)
*Emigration clearance required **Emigration clearance not required
(b) EDUCATIONAL QUALIFICATION (in order to determine emigration status)

19. PERMANENT ADDRESS IN INDIA TEL. NO.

20. (a) PERMANENT ADDRESS IN USA (attach 2 proofs of residence) (b)email TEL. NO.
Home
Work
(b) ALIEN REGISTRATION CARD (GREEN CARD), EMPLOYMENT AUTHORIZATION CARD NUMBER
(Please attach a photocopy)
21. PRESENT PASSPORT NO. OR DAMAGED OR LOST PASSPORT NO.

Date of Issue Place of Issue Date of Expiry

(THESE DETAILS MUST BE PROVIDED OTHERWISE APPLICATION WILL REMAIN UNPROCESSED)

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 22. ARE YOU A CITIZEN OF INDIA BY
____ Birth ____ Descent ____ Naturalization ____Registration?
23. DID YOU EVER POSSESS ANY OTHER NATIONALITY OR TRAVEL DOCUMENT OF ANY OTHER COUNTRY? If so, please give details

24. IS THIS APPLICATION FOR A PASSPORT FOR THE

____ First time, or, ____ New passport in replacement of an expired passport, or, ____ Duplicate passport?
25. IF THIS APPLICATION IS FOR A DUPLICATE PASSPORT, WAS THE PREVIOUS PASSPORT LOST OR DAMAGED? (if damaged, please attach damaged passport)

26
. (a) NAME OF APPLICANT’S ELDEST SON OR DAUGHTER (First child)

(b) NAME OF APPLICANT’S ELDEST BROTHER OR SISTER

27
. WERE YOU EVER REFUSED A PASSPORT? WAS YOUR PASSPORT EVER ORDERED TO BE IMPOUNDED OR REVOKED?
____ Yes ____ No ____ Yes ____ No
If answer to any of these questions is YES, please enclose a copy of the official communication received by you and give other
details
28. LOCAL DRIVER’S LICENSE NUMBER OR ANY OTHER IDENTIFICATION (Please attach a photocopy)
Date of issue Place of issue
29. IS APPLICANT IN

____ Govt. service ____ public undertaking service ____ statutory bodies service of India?
If so, please give details and enclose “No Objection Certificate” from your employer in original.
30
. (a) ARE ANY CRIMINAL PROCEEDINGS PENDING AGAINST APPLICANT IN ANY COURT IN INDIA? If so, please give details.

(b) HAS APPLICANT EVER BEEN REPATRIATED FROM ABROAD TO INDIA AT THE EXPENSE OF GOVT. OF INDIA? If so, please give details

31. (a) BRIEFLY STATE CIRCUMSTANCES OF LOSS/THEFT/DAMAGE OF PASSPORT AND ATTACH REPORT LODGED WITH THE LOCAL POLICE
IN CASE OF LOSS OF PASSPORT. (Please attach your explanation on a separate sheet of paper)

(b) DETAILS OF RESTRICTION, IF ANY, PUT ON APPLICANT'S DAMAGED/LOST PASSPORT

(c) DID APPLICANT AVAIL OF TRANSFER OF RESIDENCE, FOREIGN TRAVEL SCHEME FACILITY ON LOST/DAMAGED PASSPORT?
If so, please give details.

32
. MODE OF PAYMENT:
Cash / Money order / Certified check #________________________ ; Amount US $ ___________________
CASH IS ACCEPTED ONLY AT THE COUNTER
33. DECLARATION:
I solemnly affirm that
(i) I owe allegiance to the sovereignty and integrity of India, and
(ii) Information given above in respect of myself, my son/daughter/ward is correct and nothing has been concealed and I am aware
that it is an offense under the Passport Act 1967 to knowingly furnish false information or suppress material information, which
attract penal and other punishments under the acts.
(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) The information furnished by me in this form is correct.
(vi) I have neither applied for, nor been granted asylum.
(vii) I have read the passport guidelines, fees and mailing information carefully.

(Signature or thumb impression of applicant or his/her legal guardian/parent)

(Left thumb impression of male and right thumb impression of female)
Place

Date:

TWO SPECIMEN SIGNATURES OF APPLICANT ONLY (Thumb impressions, in case of an infant)

APPLICATION WILL REMAIN UNPROCESSED WITHOUT APPLICANT 'S SPECIMEN SIGNATURES

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 Checklist for New Passport

Please read carefully before submitting the application

1. Duly filled and signed passport application.

2. Passport in Original and photocopy of first page and last page.

3. Three recent passport size photographs (3.5 cm x 3.5 cm -front facial

pose). Photograph should have a white or a light coloured background.
(Photograph with coloured or dark glasses or in uniform or in
Polaroid prints or Computer prints will not be accepted).

4. Fee structure:

(i) Passport fee $40 for ordinary passport expiring after ten years.
Passport fee for minor $ 25 for ordinary passport.

(ii) $50 for ordinary Jumbo Passport (60 pages).

5. Return mail fee $20 or self-addressed duly stamped USPS express mail
envelope only.

6. Passport fee can be combined with mailing charges (Cashier’s Check or

Money Order only – We do not accept personal checks).

7. Photocopy of Green Card/Work Authorization Card or H1B/H4, L1/L2,

J1/J2 etc. – approval notice (whichever is applicable).

8. Two proofs of residence (driver’s license, Insurance Policy, Bank

Statement, Lease Agreement utility bills etc.).

9. A photocopy of marriage certificate (in case, the name of spouse has not
been included in the Passport.

10. Submit notarized affidavit if the Passport has expired more than one year
ago.
11. Submit notarized affidavit with photograph for change of appearance
from beard to non-beard & vice-versa, turban to non-turban & vice-versa
& from childhood photo to attaining young age.

Note: If the application is found in order and no prior reference is required to be

made to the original passport issuing authority, a new passport will be issued after 3
days at the counter and within 5 working/business days received by mail from the
date of receipt of the application. If the case requires prior reference, process may
take 30 working business days from the date of application.
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