Passport Application Form: Specimen Verification Certificate

(Official stationery of verifying authority)

Reference Number

(Verification Certificate issuing officer should attest the photograph of the applicant with his/her signature and rubber stamp in such a way that half the signature and stamp appear on the photograph and half on the certificate).

This is to certify that Sh./Smt./Kum. ……………………….. son/wife/daughter of …………………. whose personal particulars are given below has good moral character and reputation and that after having read the provisions of Section 6(2) of the Passports Act, 1967. I certify that these provisions are not attracted in case of this applicant and I, recommend issue of an Indian Passport to him/her. Applicant has been staying at his/her address continuously for the last one year.

Date of Birth ……………………………….

Place of Birth ……………………………….

Educational Qualification ……………………………….

Profession……………………………………………………………...

Permanent Address ………………………………..

Present Address ………………………………..

Place

Office Address with location

Date: Signature …………………….

1. The applicant’s passport size photograph is also required to be affixed on the Verification Certificate and attested by the officer issuing the Verification Certificate with his/her signature and rubber stamp in such a way that half the signature and stamp appear on the photograph and half on the certificate.

2. If the applicant has resided at more than one place during the last one year then all previous addresses with the relevant dates should be mentioned.

3. Anyone who issues incorrect verification certificate may be prosecuted under section 12(2) of the Passport Act, 1967.

"Subject to the other provisions of this Act, the passport authority shall refuse to issue a passport or travel document for visiting any foreign country under clause ( C ) sub-section 5 of anyone or more of the following grounds, and on no other ground, namely:

(a) that the applicant is not a citizen of India.

(b) that the applicant may, or is likely to engage outside India in activities prejudicial to the sovereignty and integrity of India.

(c) that the departure of the applicant from India may, or is likely to be detrimental to the security of India.

(d) that the presence of the applicant outside India may, or is likely to prejudice the friendly relations of India with any foreign country.

(e) that the applicant has, at any time during the period of five years immediately preceding the date of his application been convicted by a court of India for any offence involving moral turpitude and sentenced in respect thereof imprisonment for not less than two years.

(f) that criminal proceedings in respect of an offence alleged to have been committed by the applicant are pending before a court in India.

(g) that a warrant or summons for the appearance, of a warrant for the arrest, of the applicant has been issued by a court under any law for the time being in force or that an order prohibiting the departure from India of the applicant has been made by any such court.

(h) That the applicant has been repatriated and has not reimbursed the expenditure incurred in connection with such repatriation.