ANNEXURE ‘F’
SPECIMEN VERIFICATION CERTIFICATE (FOR PASSPORT UNDER TATKAAL ONLY) (On official letter head of verifying authority)
(To be given in Duplicate* along with Standard Affidavit as at Annexure “I”)

 

Reference Number Applicant’s Photo

Verification 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 (Govt./Private Service/Others) _ _ _ _ _ _ _ _ _ _ _ _ _ _
Permanent Address _ _ _ _ _ _ _ _ _ _ _ _ _ _
Present Address _ _ _ _ _ _ _ _ _ _ _ _ _ _
Place
Office Address with location
Date:		 Signature
Office Seal
Full Name _ _ _ _ _ _ _ _ _ _ _ _
Designation _ _ _ _ _ _ _ _ _ _ _ _
I Card No. _ _ _ _ _ _ _ _ _ _ _ _
(Enclose a photocopy of I Card)
Telephone No.
(O)_ _ _ _ _ _ _ _ _ _ _ _
(R)_ _ _ _ _ _ _ _ _ _ _ _
Mobile No _ _ _ _ _ _ _ _ _ _ _ _