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This document is an application form for various consular services from the Embassy of India in Washington DC. It requests information such as the applicant's name, date and place of birth, passport details, addresses in India and the US, and services requested. Such services include birth/marriage certificates, police clearance, document attestation, life certificates, address changes on passports, and more. The applicant must provide photos, signatures, payment and declarations of Indian citizenship and allegiance.

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Joseph S. Reddy
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36 views

Form PDF 38

This document is an application form for various consular services from the Embassy of India in Washington DC. It requests information such as the applicant's name, date and place of birth, passport details, addresses in India and the US, and services requested. Such services include birth/marriage certificates, police clearance, document attestation, life certificates, address changes on passports, and more. The applicant must provide photos, signatures, payment and declarations of Indian citizenship and allegiance.

Uploaded by

Joseph S. Reddy
Copyright
© Attribution Non-Commercial (BY-NC)
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 (CONSULAR WING)


2536 Massachusetts Avenue, NW, Washington, DC 20008

PASTE

Tel: (202) 939-9867 Fax: (202) 387-6946 http://www.indianembassy.org

APPLICANT'S

APPLICATION FOR MISCELLANEOUS SERVICES

RECENT PHOTO

[This application may be used at the Embassy of India, Washington, DC or at


any other Consulate General of India in USA.]

HERE (2X 2)

(i) Please send the original valid Passport


(ii) Please fill the form in BOLD letters.
(iii) Declaration at Section V should be signed by Indian Citizens only
PLEASE [X] MARK THE SERVICE APPLIED FOR:
[
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] Birth / Marriage Certificate (Fee $20/) (Fill Section II also )


] Police Clearance Certificate (Fee $20/-)
] Attestation of civil documents (Affidavits, sponsorship certificates, Will
, etc (Fee $10/-) (per signature)
] Life Certificate (gratis) Mailing fee is required wherever applicable)
] Attestation for property related documents; Power of Attorney to be filled in duplicate) (Fee $20/-) (per signature)
] No Obligation to Return to India (Fee $60/-)
] Change of address, addition/deletion & other miscellaneous services on the passport (Fee $10/-) (Fill Section IV also)
] Attestation of Drivers License (Fee $10/-)
] No Objection Certificate for carrying dead body/ashes (Fee $1/-)

[ ] Others (Please specify)___________________________________________________________________


1. APPLICANTS NAME AS IN PASSPORT______________________________________________________________________________ _
(Surname

/ Last Name)

(Middle Name)

(Given / First Name)

2.FULL NAME OF FATHER _____________________________________________ 3. FULL NAME OF MOTHER: _______________________________


4. PLACE & COUNTRY OF BIRTH OF APPLICANT: ______________________________________________________________________________________________
5. DATE OF BIRTH OF APPLICANT:( DD/MM/YYYY): ________________________________________________________________________
6. NAME AND NATIONALITY OF SPOUSE: _______________________________________________________________________________
7. PERMANENTADDRESS IN INDIA: ___________________________________________________________________________________________________________
_________________________________________________________________________________________________ ___________________________________________________

8. ADDRESS IN USA:: _________________________________________________________________________________________________________________________ _


____________________________________________________________________________________________________________________________________________________

9. PROFESSION & BUSINESS ADDRESS: _______________________________________________________________________________


________________________________________________ TEL: ______________________________ EMAIL: _______________________________
10:CURRENT PASSPORT NO.:_________________________

11. PLACE & DATE OF ISSUE:___________________________________

12. DATE OF EXPIRY: ________________________________

PLACE

DATE

SIGNATURE
PAGE 1 OF 2

SECTION II (FOR REGISTRATION OF BIRTH)

PLEASE REGISTER THE FOLLOWING CHILD/CHILDREN NAME(S) AND ISSUE BIRTH CERTIFICATE(S) TO THEM AS INDIAN
CITIZENS.
CHILDS NAME

DATE & PLACE OF BIRTH

SEX (M/F)

NOTE: The passport of both the parents and the photocopy of the Birth Certificate(s) of the above child/children should be attached. Declaration
of both parents that they have not taken any other nationality for the child / children also to be attached.
SECTION III (FOR ADDITION/DELETION OF CHILDS NAME FROM MY PASSPORT)

CHILDS NAME

DATE & PLACE OF BIRTH

SEX (M/F)

SECTION IV (FOR CHANGE OF PERMANENT ADDRESS ONLY )

OLD ADDRESS
NEW ADDRESS

SECTION V DECLARATION (TO BE SIGNED BY INDIAN CITIZENS ONLY)


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.

(iii)

I solemnly declare that I have not lost, surrendered or been deprived of my Indian Citizenship

(iv)

I further declare that I have not voluntarily acquired citizenship of any other country and I have no other
passport or travel document in my possession
(This declaration has to be notarized by a Notary Public in case of an applicant whose passport expired more
than six months before the date of the submission of this application.

Place

Date

Signature

MODE OF PAYMENT:
(I)
CASHIERS CHECK OR MONEYORDER DRAWN IN FAVOR OF EMBASSY OF
INDIA.
(II)
CASH IS ACCEPTED ONLY AT THE CONSULAR SECTION COUNTER.
(III)
PERSONAL CHECKS/ CREDIT CARDS ARE NOT ACCEPTED
PAGE 2 OF 2

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