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SPECIMEN VERIFICATION CERTIFICATE (FOR PASSPORT UNDER TATKAL ONLY)
(On official stationery of verifying authority)
(To be given in Duplicate* along with Standard Affidavit as at Annexure I )
(Verification Certificate issuing officer should attest the photograph of the applicant with his/her signature and rubber stamp in such a way that half the signature and stamp appear on the photograph and half on the certificate).
This is to certify that Sh./Smt./Kum. .. son of/wife of/daughter of . whose personal particulars are given below has good moral character and reputation and that after having read the provisions of Section 6(2) of the Passports Act, 1967. I certify that these provisions are not attracted in case of this applicant and I, recommend issue of an Indian Passport to him/her. Applicant has been staying at his/her address continuously for the last one year.
Date of Birth .
Place of Birth .
Educational Qualification .
Profession (Govt./Private Service/Others) ..
Permanent Address ..
Present Address ..
Office Address with location
Date: Signature .
Full Name .
I Card No.
(Enclose a photocopy of I Card)
Telephone No. (O) ..(R)
1. The applicants passport size photograph is also required to be affixed on the Verification Certificate and attested by the officer issuing the Verification Certificate with his/her signature and rubber stamp in such a way that half the signature and stamp appear on the photograph and half on the certificate.
2. If the applicant has resided at more than one place during the last one year then all previous addresses with the relevant dates should be mentioned.
3. This Verification Certificate may be got signed by any of the following:
(i) An Under Secretary/Deputy Secretary/Director/Joint Secretary/Add. Secretary/Special Secretary/Secretary/Cabinet Secretary to Government of India.
(ii) A Director/Joint Secretary/Additional Secretary/Special Secretary/Chief Secretary to a State Govt.
(iii) A Sub-Divisional Magistrate/First class Judicial Magistrate/Additional DM/District Magistrate of the district of residence of applicant.
(iv) A District Superintendent of Police, DIG/IG/DGP of district of residence of applicant.
(v) A Major and above in the army, Lt. Commander and above in the Navy and Sq. Leader and in the Air Force.
(vi) The General Manager of a Public Sector Undertaking
(vii) All members of any All India Service or Central Service who are equivalent to or above the rank of an Under Secretary to the Government i.e. in the pay scale of Rupees 10,000-15,200 or above.
(viii) Resident Commissioners/Additional Resident Commissioners of all State Governments based in Delhi.
(ix) Concerned Tehsildars or Concerned SHOs for an applicant staying in the area under his/her jurisdiction.
(x) The Chairmen of the Apex Business Organizations i.e.FICCI, CII and ASSOCHAM in respect of owners, partners or directors of the companies that are members of the concerned Chamber in prescribed performa as at Annexure J.
4. Anyone who issues incorrect verification certificate may be prosecuted under section 12(2) of the Passport Act, 1967.
5. 5. SECTION 6(2) (C) OF THE PASSPORT ACT, 1967
Subject to the other provisions of this Act, the passport authority shall refuse to issue a passport or travel document for visiting any foreign country under clause ( C ) sub-section 5 of anyone or more of the following grounds, and on no other ground, namely:
(a) that the applicant is not a citizen of India.
(b) that the applicant may, or is likely to engage outside India in activities prejudicial to the sovereignty and integrity of India.
(c) that the departure of the applicant from India may, or is likely to be detrimental to the security of India.
(d) that the presence of the applicant outside India may, or is likely to prejudice the friendly relations of India with any foreign country.
(e) that the applicant has, at any time during the period of five years immediately preceding the date of his application been convicted by a court of India for any offence involving moral turpitude and sentenced in respect thereof imprisonment for not less than two years.
(f) that criminal proceedings in respect of an offence alleged to have been committed by the applicant are pending before a court in India.
(g) that a warrant or summons for the appearance, of a warrant for the arrest, of the applicant has been issued by a court under any law for the time being in force or that an order prohibiting the departure from India of the applicant has been made by any such court.
(h) That the applicant has been repatriated and has not reimbursed the expenditure incurred in connection with such repatriation.
DECLARATION OF APPLICANT PARENT OR GUARDIAN IF PASSPORT IS FOR MINOR (one parent not given consent) : IN THE FORM OF A SWORN AFFIDAVIT BEFORE JUDICIAL MAGISTRATE ON NON-JUDICIAL STAMP PAPER
I/We .solemnly declare and affirms as follows:
(Name of the Parent/Guardian applying for passport)
1. That I/We am/are the mother/father/parents/guardians of ..who is a minor child and on whose behalf (Name of the Minor Child)
I/We have made an application for his/her passport.
2. Signature/Consent of Mr/Mrs .who is father/mother/parents of the child has not (Name of the father/Mother)
been obtained by me for the following reasons:
3. That I/We only am/are taking care of he/she is exclusively in my physical custody. (Name of the minor child)
4. I/We also affirm that in the case of a court case arising due to issue of a passport to the minor child .
(Name of the minor child)
I/We would be solely responsible for defending the case and not the Passport Issuing Authority.
Signature & Address of the parent (s)
guardian(s) applying for the Passport
DECLARATION OF APPLICANT PARENT OR GUARDIAN IF PASSPORT IS FOR MINOR: ON PLAIN PAPER
I/We affirm that the particulars given above are in respect of (name of the child) son/daughter of Shri. and Shrimati of whom I/we am/are the Parents/Single Parents/Applicant Parent/Guardians. He/She is a Citizen of India. His/Her date of birth/place of Birth is ----------. I/We undertake the entire responsibility for his/her expenses. I/We solemnly declare that he/she has not lost, 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. It is also certified that I/we am/are holding/not holding valid Indian passport(s) and the name of the child mentioned is not included in Passport of either parent.
_____________ / _________________ OR___________________
Father (Signature) Mother (Signature) Legal Guardian (Signature)
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