11B

TO BE FILLED IN DUPLICATE

SWORN AFFIDAVIT
MISCELLANENOUS
I_____________________________________ aged ________________ years residing in
___________________________with telephone no ____________________Post Box No
___________ Holder of Indian Passport No. _______________issued at_____________
On______________ here by make oath and state as follows
_______________________________holder of Indian Passport No_________________
Issued at _____________on ______________is my son/daughter
That I could not apply his/her Passport in time due to___________________________
I solemnly declare that he/she is an Indian National______________________________
He/She have not lost/ surrendered or been deprived of Indian Citizenship.
He/She owe allegiance to India and have not acquired citizenship of any other country.
That this affidavit is true and that it conceals nothing and no part of it is false.

Place :
Date :

__________________
Signature

Mobile:

Sworn at the Consulate General of India, Dubai, on this day the___ ________200__
By Shri /smt ____________________________________, who made his /her signature
before me at Dubai. He/She has been identified with reference to his/her Passport No
__________________issued at ______________________on ___________________

THE CONSULATE GENERAL OF INDIA, DUBAI, TAKES NO RESPONSIBILITY

FOR THE CORRECTNESS OF THE ABOVE STATEMENT.