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Auto-filled Annexure D

ANNEXURE ‘D’
SPECIMEN DECLARATION BY APPLICANT’S PARENT(S) OR GUARDIAN
FOR ISSUE OF PASSPORT TO MINOR
(On plain paper)
I/We, parent(s)/legal guardian of minor child whose details are mentioned below solemnly declare and affirm as under:-
Name of the minor child:
Date of Birth:
Name of father
Citizenship Indian
Passport No.
Contact No.
Email ID
Address
Name of Mother
Citizenship Indian
Passport No.
Contact No.
Email ID
Address
1. That I/We am/are the mother/father/parent(s)/legal guardian(s) of the above minor child on whose behalf I/We am/are submitting passport application vide ARN no ..................
2. The minor child mentioned above is a citizen of India. I/We solemnly declare that he /she has not lost, surrendered or has been deprived of his/her citizenship of India.
3. I/We undertake the entire responsibility for his/her expenses.
4. I/We hereby certify and undertake that if any information provided in the above declaration is found incorrect or misleading, following action may be taken by the Passport Authority for:
a) Cancellation (impounding/ revocation) of the passport issued on the basis of this declaration;
b) Initiating criminal proceedings under relevant provisions of Bharatiya Nyaya Sanhita, 2023 and the Passports Act, 1967
Signature of father/legal guardian...........................
Name of father
Passport no: (preferably) ; or
Aadhaar Card No ; or
Voter ID Card No ; or
PAN Card No ; or
Driving License No
Signature of Mother/Legal Guardian...........................
Name of Mother
Passport no: (preferably) ; or
Aadhaar Card No ; or
Voter ID Card No ; or
PAN Card No ; or
Driving License No
Date:
Place:
Note:
  1. In case of ‘Legal guardian’, copy of court order appointing ‘Legal guardian’ of minor to be attached.
  2. Section 5 of the Passports Act 1967 read with Rule 5 of the Passports Rules, 1980 stipulates that Passport Authority may make all such enquiry and may require an applicant to furnish such additional information, documents or certificates, as may be considered necessary by the Passport Authority for the proper disposal of the application required.
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