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  • PERFORMA FOR VERIFICATION OF NATIONALITY STATUS/ANTECEDENTS

    (PLEASE TYPE OR PRINT)

    1. FULL NAME: ____________________________________________________

    2. ALIASES, IF ANY: ____________________________________________________

    3. (a) FULL NAME OF FATHER: ____________________________________________________

    (b) FULL NAME OF MOTHER: ____________________________________________________

    (c) FULL NAME OF SPOUSE: ____________________________________________________

    4. DATE AND PLACE OF BIRTH: ____________________________________________________

    (DD-MM-YYYY) (VILLAGE) (DISTRICT)

    5. PRESENT OCCUPATION: ____________________________________________________

    6. NATIONALITY: ____________________________________________________

    7. PRESENT ADDRESS IN USA ____________________________________________________

    ____________________________________________________

    8. COMPLETE PERMANENT ADDRESS IN INDIA: _______________________________________

    ____________________________________________________

    ____________________________________________________

    9. DETAILS OF PASSPORT: PASSPORT NO:______________ DATE OF ISSUE: _____________

    PLACE OF ISSUE: ____________ DATE OF EXPIRY: ____________

    10. VISBILE DISTINGUISHING MARKS IF ANY:_____________________________________________

    11. DATE OF LEAVING INDIA: ____________________________________________________

    12. PERIOD OF STAY ABROAD: ____________________________________________________

    13. DATE OF LOSS OF PASSPORT: ____________________________________________________

    14. NAME & ADDRESS OF TWO (1) _________________________________________________

    RELATIVES / FRIENDS (AT THE ________________________________________________________________________ PLACE OF PERMANENT RESIDENCE IN (2) _____________________________________________________________________

    INDIA, Given In Sr.8 Above) ___________________________________________________

    15. NAME & ADDRESS OF TRAVEL ____________________________________________________

    AGENT INVOLVED IN SENDING ____________________________________________________

    THE INDIVIDUAL ABROAD ____________________________________________________

    NOTE: Please Complete all entries Legibly and fully: Incomplete Information will only lead to delay in the process of issuing passport.

    Paste one passport size

    photograph here (2 X 2)


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