"Application for Miscellaneous Services - Embassy of India" - Washington, D.C.

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EMBASSY OF INDIA (CONSULAR WING)
2 5 36 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
HERE (2”X 2”)
any other Consulate General of India in USA.]
(i) Please read the instructions at page 3 before filling the form
(ii) Please fill the form in BOLD letters.
(iii) For power of Attorney and Life Certificate sent by mail, the signatures of the
should be notarized.
(iv) Declaration at Section V should be signed by Indian Citizens only
PLEASE [X] MARK THE SERVICE APPLIED FOR:
[ ] Emigration Clearance waiver (Fee $10/-)
[ ] Endorsement on Identity Certificate (Fee $5/-)
[ ] Birth / Death/Marriage Certificate (Fee $20/) (Fill Section II also )
[ ] Police Clearance Certificate (Fee $20/-)
[ ] Attestation of civil documents (ffidavits, educational degree, sponsorship certificates, Willa , 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)
[ ] Attestation for Commercial Documents ( to be filled in duplicate)(Fee $50/-) (per signature)
[ ] Attestation for documents for sale, purchase of ship, vessel (to be filled in duplicate) (Fee $261/-)
[ ] No Obligation to Return to India (Fee $60/-)
[ ] Registration of Marriage (Fee $50/-)
[ ] Change of address, addition/deletion & other miscellaneous services on the passport (Fee $10/-) (Fill Section IV also)
[ ] Attestation of Driver’s License (Fee $10/-)
[ ] No Objection Certificate for carrying dead body/ashes (Fee $1/-)
[ ] NORI Waiver Certificate (Fee $20/-)
[ ] NRI Certificate (Fee $20/-)
[ ] Others (Please specify)___________________________________________________________________
1. APPLICANT’S 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 3
EMBASSY OF INDIA (CONSULAR WING)
2 5 36 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
HERE (2”X 2”)
any other Consulate General of India in USA.]
(i) Please read the instructions at page 3 before filling the form
(ii) Please fill the form in BOLD letters.
(iii) For power of Attorney and Life Certificate sent by mail, the signatures of the
should be notarized.
(iv) Declaration at Section V should be signed by Indian Citizens only
PLEASE [X] MARK THE SERVICE APPLIED FOR:
[ ] Emigration Clearance waiver (Fee $10/-)
[ ] Endorsement on Identity Certificate (Fee $5/-)
[ ] Birth / Death/Marriage Certificate (Fee $20/) (Fill Section II also )
[ ] Police Clearance Certificate (Fee $20/-)
[ ] Attestation of civil documents (ffidavits, educational degree, sponsorship certificates, Willa , 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)
[ ] Attestation for Commercial Documents ( to be filled in duplicate)(Fee $50/-) (per signature)
[ ] Attestation for documents for sale, purchase of ship, vessel (to be filled in duplicate) (Fee $261/-)
[ ] No Obligation to Return to India (Fee $60/-)
[ ] Registration of Marriage (Fee $50/-)
[ ] Change of address, addition/deletion & other miscellaneous services on the passport (Fee $10/-) (Fill Section IV also)
[ ] Attestation of Driver’s License (Fee $10/-)
[ ] No Objection Certificate for carrying dead body/ashes (Fee $1/-)
[ ] NORI Waiver Certificate (Fee $20/-)
[ ] NRI Certificate (Fee $20/-)
[ ] Others (Please specify)___________________________________________________________________
1. APPLICANT’S 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 3
SECTION II (FOR REGISTRATION OF BIRTH)
PLEASE REGISTER THE FOLLOWING CHILD/CHILDREN NAME(S) AND ISSUE BIRTH CERTIFICATE(S) TO THEM AS INDIAN
CITIZENS.
CHILD’S 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 CHILD’S NAME FROM MY PASSPORT)
CHILD’S 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 3
GUIDELINES FOR MISCELLANEOUS PASSPORT AND CONSULAR SERVICES
a. CHANGE OF ADDRESS: Submit completed Miscellaneous Services form with a fee of $10/- and
passport in original
b. EMIGRATION CHECK NOT REQUIRED (ECNR): Submit completed Miscellaneous Services form with a
fee of $10/-,passport in original and documents in support of eligibility for the endorsement
c. DELETION OF CHILD'S NAME: Submit completed Miscellaneous Services form with a fee of $10/- and
passport in original
d. BIRTH CERTIFICATE: Submit completed Miscellaneous Services form with a fee of $20 and passport in
original
e. MARRIAGE CERTIFICATE: In case the name of the spouse is endorsed on the passport, fill in the
Miscellaneous Services form and submit with applicant’s and spouse's passport in original with a fee of $20/-
. In case the name of spouse is not endorsed on the passport, apply for endorsement of the name of
spouse first.
f. LIFE CERTIFICATE: Submit completed Miscellaneous Services form with one recent photograph and
passport in original. The form should be signed at the Consular Counter. In case the application is sent by
mail, signature of the applicant should be notarized. This service is provided gratis to pensioners.
g. POLICE CLEARANCE CERTIFICATE: Submit completed Miscellaneous Services form with fee of $20/
and original passport.
h. ATTESTATION OF TRUE COPIES: Submit completed Miscellaneous Services form, documents in
original with two sets of photocopies and passport in original with a fee of $10/-
i. DEATH CERTIFICATE: For transportation of human remains (body of the deceased) the following
documentation is required: (1) Passport of the deceased; (2) Certified copy of the Death Certificate (by
Registrar of Birth & Death; Embalmer’s Certificate (Funeral Home Certificate in original stating that the body
has been embalmed in accordance with the rules and regulations of international shipping and that the body
has been placed in a hermetically sealed container with zinc liner and wooden outer container (3) No
communicable disease certificate from the Department of Health stating that the deceased did not have any
communicable diseases/contagious diseases; (4) Burial/Transit permit ; and (5) a Fee of $1/-. For
transportation of ashes the following documentation is required (1) Passport of the deceased; (2) Certified
copy of the Death Certificate (by Registrar of Birth & Death; (3) Cremation certificate; and (4) a Fee of $1/-.
All documents must be submitted in original along with one set of photo- copy.
j. SPONSORSHIP DECLARATION FORM: The form in prescribed proforma has to be submitted in
duplicate. The form is to be signed at the consular counter passport in original and a fee of $10/- is required.
k. ATTESTATION OF ADOPTION DOCUMENTS: The documents should be certified by the Department of
State of the concerned State Government and submitted in duplicate. Passport is not required. Fee is $10/-
for each signature.
l. ATTESTATION OF AN AFFIDAVIT FOR ISSUE OF CHILD’S PASSPORT: This is required when one of
the parents of the child is staying abroad and passport is to be issued to the child in India afresh or after
deletion of the child’s name in the passport of the parent resident in India. The affidavit in the prescribed
proforma has to be submitted in duplicate along with the passport of the parent staying abroad. Fee is $10/-.
m. ATTESTATION OF DOCUMENTS OR POWER OF ATTORNEY (NOT RELATED TO PROPERTY
MATTERS): To be submitted in duplicate duly notarized or the person can come and sign at the counter in
which case notarization is not necessary. Original passport is required. Fee is $10/.
n. ATTESTATION OF DOCUMENTS OR POWER OF ATTORNEY (RELATED TO PROPERTY
MATTERS): To be submitted in duplicate duly notarized or the person can come and sign at the counter in
which case notarization is not necessary. Passport in original is required. Fee is $20/-.
o. ATTESTATION OF FOREIGN PUBLIC DOCUMENTS (RELATING TO COMMERCIAL MATTERS)
http://www.indianembassy.org/
Please see our website
in section dealing with Power of Attorney. Fee
is $50/-
NOTE: PLEASE INCLUDE RETURN MAILING CHARGES WHEREVER APPLICABLE. CURRENT
CHARGES ARE $20 FOR EXPRESS MAIL AND $10 FOR PRIORITY MAIL. FOR ATTESTATION OF
CIVIL DOCUMENTS AND POWER OF ATTORNEY, THE APPLICANT IS REQUIRED TO AFFIX ONE
PHOTOGRAPH AT THE END OF THE DOCUMENT ALONG WITH SPECIMEN SIGNATURE.
SIGNATURES AND ADDRESSES OF TWO WITNESSES ARE TO BE FURNISHED (WHEREVER
APPLICABLE).
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