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I SHABNAM ABDUL RAZAK SHAIKH solemnly declare and affirm the following: 1. That I am the mother of FARHAN PATNI who is a minor and on whose behalf I have made an application for his passport. 2. Signature/Consent of Mr. FARUKH PATNI who is father of the child has not been obtained by me for the following reasons: He has deserted me after delivery. 3. That I only am taking care of FARHAN PATNI and he is exclusively in my physical custody. 4. I also affirm that in the case of a court case arising due to issue of a passport to the minor child FARHAN PATNI I would be solely responsible for defending the case and not the Passport Issuing Authority.
Date: 15/01/2014 Signature of Deponent: ________________________ Address of Deponent: Room No. C-10, Building No. E1-30, Sahyog Apartments, Sector 10, Nerul, Navi Mumbai 400706.