How Stuffs Work

ANNEXURE ‘L’

SPECIMEN AFFIDAVIT FOR A PASSPORT IN LIEU OF LOST/ DAMAGED

PASSPORT

(This affidavit is to be executed on non-judicial stamp paper of minimum value in the

presence of First Class Judicial Magistrate or Executive Magistrate/Notary Public on the

following points)

I…………………………. S/o, D/o, W/o Shri……………………… residing at

…………………..solemnly affirm as follows:

1. State how and when the passport was lost/ damaged and when FIR was lodged

at which Police Station and how many passports were lost/ damaged earlier?

2. State whether you travelled on the lost/ damaged passport, if so state flight

number and date and port of entry into India?

3. State whether you availed of any TR concessions/FTs allowance and if so details

thereof?

4. State whether non-resident Indian and if resident abroad, the details of the

residence as follows:

S.No. Name of the Country

Length

of Page

Nos.

of

residence

passport bearing

From………….To departure & arrival

stamps

1.

2.

3.

5. State whether the Passport had any objection by the PIA and if so the details

thereof.

6. State whether you were deported at any time at the expense of the Government

and if so was the expenditure incurred reimbursed to Government of India.

I further affirm that I will take utmost care of my passport if issued and the Government

will be at liberty to take any legal action under the Passports Act, 1967, if the lapse is

repeated.

Date: …………………..

Deponent

Affirm before First Class Judicial Magistrate or Executive Magistrate/ Notary Public