Page 1 of 5 Form No. 1 B APPLICATION FORM FOR INDIAN PASSPORT AT AN INDIAN MISSION/POST New Passport with Change of Name (MAJOR) Please paste one 35mm x 45mm photograph here and enclose one more photograph (Please delete whatever is inapplicable) 1. Full Name (Surname) Aliases, if any Has applicant ever changed his/her name? Is so, give previous name in full Maiden name, if applicant is a married woman 2. Date of birth Place of birth Country Height cms Color of eyes Color of Hair Visible distinguishing marks, if any 3. Permanent Address In India In country of domicile 4. (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) Name & nationality of spouse 6. Name of applicant s eldest son or daughter (first child) 7. Name of applicant s eldest brother or sister 8. Present Passport/national identity card, if any No. Date & place of Applicant must paste one photograph above with half the signature on the photograph and half on the application Page 2 of 5
9. Local car Driving License No. Date & place of 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) (With documentary evidence ) 14. Profession and business address Telephone 15. Please mention, if citizen of India by birth/descent/naturalization/registration. 16. Did applicant ever possess any other nationality or travel document of any other country, if so, please give details. 17. Was applicant ever refused an Indian Passport? (Yes /No) 18. Was applicant s passport ever impounded/revoked? If so, details please (Yes /No) 19. Name and address of two relatives/friends 20. Is applicant in Govt. Service/Public Service Undertaking /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 expenses of the Govt. of India? If so, details please 22. No. of lost/damaged passport Place of Date of Valid until (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. 23. Is applicant registered with Indian Mission/Post? If not, is he a member of any Indian organization?
DECLARATION Page 3 of 5 I owe allegiance to the sovereignty and integrity of India, and information given above in respect of myself, my son/daughter/ward 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, which attract penal and other punishments under the acts and, I undertake to be entirely responsible for expenses of my son/daughter/ward. Place: Kuwait Date: Signature or Thumb Impression within the space given below: Signature or thumb impression of the applicant. (Left hand T.I. of male and right hand T.I. for female) Passport size photograph 35mm X 45mm
भ रत क र जद त व स, क व त Embassy of India, Kuwait P.O. Box: 1450, Safat 13015 Tel: 2530600/612/613/614 Fax: 2573910 Email:passport@indembkwt.org Website: www.indembkwt.org Page 4 of 5 سفارة جمهورية الهند صندوق بريد رقم : 1450 الكويت الصفاة 13015 هاتف : 2530600 614 / 613 / 612 / فاآس : 2573910 الا يميل : passport@indembkwt.org الموقع الا لكتروني : www.indembkwt.org DEED POLL / AFFIDAVIT FOR CHANGE IN NAME By this deed I, the undersigned (new name) now, previously called (old name) doing (give profession) and resident of do here by solemnly declare: 1. That for and on behalf of myself and my wife and children and remitter wholly renounce/relinquish and abandon the use of my former name / surname of (old name) and in place thereof I do hereby assume form this date the name/surname (new name) and so that I and my wife and children and remitter may hereafter be called, known and distinguished not by my former name / surname but assumed name / surname of. 2. That for the purpose of evidencing determination declare that, I shall at all times hereafter in all records, deeds and writings and in all proceedings, dealings and transactions, private as well as upon all occasions whatsoever, use and sign the name (new name) as my name in place and in substitutions of my former name (old name.) 3. That, I expressly authorize and request all persons in general, relatives, and friends in particular, at all times hereafter to designate and address me, my wife, my children, remitter, by such assumed name of (new name) accordingly. 4. In witness whereof, I have here and to subscribed my former and adopted name of (old name) and affix my signature and seal, if any, this day of. In the presence of : signed, sealed and delivered by 1. Name : Address: Tel: 2. Name : Address: Tel:
Form No.1 B Requirements for New Passport with Change of Name (Major) 1. Duly filled application Form 1B. 2. Two recent photographs (size 35mm X 45mm) with plain white background and the dress in preferably in colours offering contrast with background for clarity. 3. Original passport of the applicant. 4. First Class Magistrate Court Order duly attested by Home Dept. of the respective State Governments and thereafter by Ministry of External Affairs, New Delhi or any of its Branch Secretariat. 5. Submit newspaper cutting (full page), see note below. Fees: 21.250 (ORD) 28.300 (JUMBO) Note: Applicant should publish change of name in a leading newspaper in Kuwait and in a leading newspaper in India published from the place of his/her permanent residence. Please Note:. Applicant has to come in person.. The Applicant must produce Passport, Civil ID or any other related document in original for verification.. All copies of documents should be self attested (sign & date).. Additional documents may be needed for verification depending upon the documents submitted.