Specimen Verification Certificate

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Annexure J

ANNEXURE ‘J’

SPECIMEN VERIFICATION CERTIFICATE (To be given {in Duplicate* along with Standard Affidavit as at Annexure “I”} by Chairmen of Apex Business Organizations to the Owners, Partners or Directors of the companies having membership of the concerned chambers) (Official letter head 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.)

Verification Certificate

This is to certify that Sh./Smt./Kum. _ _ _ _ _ _ _ _ _ _ _ _ _ /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 _ _ _ _ _ _ _ _ _ _ _ _
Full Name _ _ _ _ _ _ _ _ _ _ _ _
Designation _ _ _ _ _ _ _ _ _ _ _ _
Name of the Chamber _ _ _ _ _ _ _ _ _ _ _ _
Office Seal
Telephone No. _ _ _ _ _ _ _ _ _ _ _ _
(O) _ _ _ _ _ _ _ _ _ _ _ _
(R) _ _ _ _ _ _ _ _ _ _ _ _
Mobile No _ _ _ _ _ _ _ _ _ _ _ _

Notes:

  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 put 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 Passports Act, 1967.
  4. Refer Annexure ‘F’ for details of Section 6(2) of the Passports Act, 1967.