ĐĎॹá>ţ˙ bdţ˙˙˙a˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙˙ěĽÁ'` đż?$bjbj{P{P .6::6˙˙˙˙˙˙¤ôôôěěěě ř4ŕSî88888ƒS…S…S…S…S…S…SÎTh6WŒ…Sô´Ű@´´…S88ŁšSÔÔÔ´L 8ô8ƒSÔ´ƒSÔÔjNź´@ô?S8, ŕfś>8ŤĘě<ĂO2_S$°S0ŕSőOJÂW<|ÂWd?SÂWô?S 9ĚÔ¤Š …S…S¸ŕS´´´´ä ěě˙˙˙˙ EAP-1 APPLICATION FORM FOR INDIAN PASSPORT Please paste one 3.5 cm x 3.5 cm colour photograph here and enclose two more photographs  (For the issue of an ordinary international passport Fresh/After 10 years (Final)/and for duplicate in lieu of lost/damaged passport) [Applicant must paste one photograph with half the signature on the photograph and half on the application] Payment of fee (to be filled by applicant) Amount paid C$____________________by Cash/Bank Draft/Money Order/Bank Certified cheque (Mode of payment) Full name _____________________________________________ (Surname) (First Name) (Other Names) (b) Aliases, if any____________________________________________ (c) Has applicant ever changed his/her name? If so, give previous name in full _____________________________________________________ (d) Maiden name, if applicant is a married woman__________________ 2. Date of Birth ______________Place of birth ______________________ (DD/MM/YYYY) 3. Permanent address/Telephone numbers (i) In India _______________________ _____________________________________ _________________________________________ Tel:_______________ (ii) In country of domicile (Canada) _________________________ __________________________________________Tel:__________________ (i ) Name of father________________________ Country of his birth______________ (ii) Name of mother______________________ Country of her birth______________ (iii) Nationality of father at the time of applicant’s birth___________ (iv) Nationality of mother at the time of applicant’s birth__________ 5. Married/Unmarried (Tick mark) 6. Name and nationality of Spouse_________________________________ 7. (i) Name of applicant’s eldest son or daughter (first child) ________________________ (ii) Name of applicant’s eldest brother or sister ________________________________ 8. Present passport/national identity card, if any No.______________________________ Date and place of issue_________________________ 9. Local car driving Licence No. ____________ Date and place of issue______________ 10. Educational qualification_____________________________________ (In order to determine emigration status) 11. When did applicant first leave India_________ When was he/she in India last______ 12. How long has applicant continuously resided abroad?______________ 13. Present Emigration Status (ECR or ECNR)____ECR/ECNR 14. Profession and business address in the country of domicile (Canada)____________________________________Telephone_________________  15. Please mention, if citizen of India by birth/descent/ naturalisation/registration______________________________________ 16. Did applicant ever possess any other nationality or travel document of any other country? If so, please give details (Please tick). 17. Was applicant ever refused an Indian passport (Yes/No) 18. Was applicant’s passport ever impounded/revoked? (Yes/No) If so, please give details. 19. Name, address and telephone number(s) of two relatives/friends in the country of domicile. (1)____________________________ (2) _________________________ ____________________________ _________________________ ____________________________ _________________________ Tel:_________________________ Tel: ______________________ 20. 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._______________ _____________________________________________ 21.(i) Are any criminal proceedings pending against applicant in any court in India? If so, please give details_________________________________ ____________________________________________________________ (ii) Has applicant ever been repatriated from abroad to India at the expense of the Govt. of India? If so, details please__________________________ 22. Number of lost/damaged passport_________________ place of issue_____________ Date of issue______________________ Valid until___________________ 23. (i) Briefly state circumstances of loss/theft/damage of passport on a plain paper and attach copy of report lodged with local police in case of loss/theft. (ii) Give details of restriction, if any, put on applicant’s damaged/lost passport. ___________________________________________________________ (iii) Did applicant avail transfer of residence, foreign travel scheme facility on lost/damaged passport? If so, details please_____________________________  24. Is applicant registered with Indian Mission/Post? If not, is he a member of any Indian Organisation?____________________________________ 25. DECLARATION: I solemnly affirm that: I owe allegiance to the sovereignty and integrity of India, and I am an Indian Citizen, and I have neither applied for nor obtained Canadian or any nationality other than Indian, and In the event of acquiring Canadian or any nationality other than Indian, I undertake not to use the Indian passport and to surrender it to the nearest Indian diplomatic mission. I am aware that in the event of failing to do so, I will be liable for action under provisions of the Indian Passports Act 1967 and related laws, and I hereby authorise all government authorities including the Department of Citizenship, Immigration and Police in Canada or any other country to reveal to the Govt. of India or its Diplomatic Missions all records and information that they may possess on my behalf concerning my Immigration/Citizenship status, security clearance etc. I understand that this information will be used to assist in determining my eligibility for passport, security clearance, etc., and Information given above in respect to myself, my son/daughter/ward is correct and nothing has been concealed and I am aware that it is an offense under the Indian Passports Act 1967 to knowingly furnish false information or suppress material information, which attract penal and other punishment under the Acts, and I undertake to be entirely responsible for expenses of my son/daughter/ward   Place:_______ Date:____________ _____________________________ Signature of applicant OR thumb impression of his/her Legal Guardian(Left hand thumb impression for male and right hand thumb impression of female)  DECLARATION of parent or legal guardian in case (signature of applicant) Application is on behalf of a minor: I affirm that the particulars given above in respect of ______________________ son/daughter of Mr._________________ of whom I am the parent/legal guardian are correct to my knowledge hereof. I undertake to be entirely responsible for his/her expenses. I 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. Place:____________________________ Date:______________________  Signature of applicant OR thumb impression of his/her Legal Guardian (Left hand thumb impression for male and right hand thumb impression of female) Specimen signature OR thumb impression within the space given below:   ,38=Gľ˝ň˙2$4$?$÷ó÷óďóęóďóÜójhFkqUmHnHu hFkq>*h](hFkqhFkq5>*\ ,=Tdu‡ˆ { Ś  úőččččč}ő{{{jkd$$If–‡Ö”^ Ö\˙č  6 ”ř˙”ř˙Ö0˙˙˙˙˙˙öŒ 6Ö˙Ö˙Ö˙Ö˙3Ö4Ö‡aöbÖ $„ř˙„ř˙& #$If$a$$a$ 6$>$ţţ G ¤ ä i Ź ń   ? 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