I, ________ Son of ________ residing at ________ Date of Birth ________being an applicant for issue of passport, do hereby solemnly affirm and state as follows:
1. That the names of my parents and spouse are as follows:
(i) Father :
(ii) Mother :
(iii) Wife/Husband :
2. That I am continuously resident at the above mentioned address from________.
3. That I am citizen of ________ by ________ and that I have neither acquired the citizenship of another country nor have surrendered or been terminated of my citizenship of ________.
4. That I have not, at any time during the period of ________ years immediately preceding the date of this affidavit, been convicted by any court in ________for any offence involving moral turpitude and sentenced in respect thereof to imprisonment for not less than two years;
5. That no proceedings in respect of any criminal offence alleged to have been committed by me are pending before any criminal court in ________.
6. That no warrant or summons for my appearance, and no warrant for my arrest, has been issued by a court under any law for the time being in force, and that my departure from ________ has not been prohibited by order of any such court;
7. That I have never been repatriated from abroad back to ________ at the expense of Government of ________ /I was repatriated from abroad back to ________ at the expense of Government of ________, but reimbursed expenditure incurred in connection with such repatriation.
8. That I will not engage outside ________in activities prejudicial to the sovereignty and integrity of ________.
9. That my departure from ________ will not be detrimental to the security of ________.
10. That my presence outside ________will not prejudice the friendly relations of ________with any foreign country.
Verified on________ at ________ that the contents of the above mentioned affidavit are true and correct and nothing material has been concealed.