Form I

Embassy of India Riyadh Passport Application Form

Paste (NOT STAPLE) one

FOR OFFICE USE ONLY File No. : Receipt No. : Amt. Ppt. No. : DoI: Validity:

photo here. Size of the photo should be 3.5cm x 4.5cm.(with full frontal view of the face and no side pose photo) Photos should be in colour with light background only & without white borders.

Signature or thumb impression should be within the box only. 1. Surname Given Name Aliases, if any Gender Male ( ) / Female ( )

Has applicant ever changed his/her name ? If so, give previous name in full: Maiden Name, if applicant is a married woman: 2. Present passport No. Place of Issue 3. Date of Birth Height (Cms) 4. Fathers Name Nationality of father at the time of applicant's birth: 5. Mothers Name Nationality of mother at the time of applicant's birth: 6. 7. Married ( )/Unmarried ( In case of Minor: ) Husband/Wifes Name & Nationality Date & Place of Issue Date & Place of Issue Country of her birth Country of his birth Place & Country of Birth Colour of Eyes Colour of Hair Date of Issue Validity

Father's passport No. Mother's passport No.

8.

Present complete physical address in K.S.A with name of street etc.

Tel. Office 9. Permanent Address in India

Res.

Mobile

City/State 10. 11. 12. Educational Qualification Sponsors name, ID and tel.no. When did applicant first leave India

Tel. No. Profession

When was he/she last in India:

Do not write below this line. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------This form is free of charge. Photocopy of this form is acceptable. The form may also be downloaded from our web site: www.indianembassy.org.sa . If there is a change/addition in any particular such as address, spouse name etc. please also submit the Miscellaneous form (Form 2) with documentary proof. If necessary, clearance shall be sought of the concerned authorities in India before the service is rendered.

-2 13. 14. 15. How long has applicant continuously resided abroad? Please mention, if citizen of India by Birth/Descent/Naturalization/Registration. Did applicant ever possess any other nationality or travel document of any other country, if so, please give details:

16. 17. 18. (i)

Was applicant ever refused an Indian passport ? (Yes/No) Was applicant's passport ever impounded/revoked ? If so, details please. (Yes/No) Name and address of two relatives/friends in K.S.A / India: (ii)

19. 20.

Is applicant in Govt. Service/Public Undertaking Service/Statutory Bodies Services of India? If so, please give details and enclose 'No objection certificate' from you employer in original. (i) Are any criminal proceedings pending against the applicant in any court in India? If so, please give details : (ii) Has applicant ever been repatriated from abroad to India at the expenses of the Govt. of India? If so please give details :

21.

No. of lost/damaged passport Place of issue

Date of issue Valid Until

(i) Briefly state circumstances of loss/theft/damage of passport on a plain paper and attach copy of report lodged 22. with local police in case of loss/theft. (ii) Give details of restriction, if any, put in applicant's damaged/lost passport. (ii) Did applicant avail transfer of residence, foreign travel scheme facility on lost/damaged passport ? If so, details please 23. Is applicant registered with Indian Mission/Post ? If not, is he a member of any Indian Organisation ?

24. Name

Next of kin/friend to contact in case of emergency: In KSA In India

Complete address Phone (land-line & mobile) DECLARATION : I solemnly affirm that : (i) I owe allegiance to the sovereignty and integrity of India, and (ii) Information given above in respect of myself, my son/daughter/ward is correct and nothing has been concealed and I am aware that it is an offence under the Passport Act, 1967 to knowingly furnish false information or suppress material information, which attract penal and other punishments under the acts, and (iii) I undertake to be entirely responsible for expenses of my son/daughter/ward.
Please sign here

Place Date

Signature or T.I. of the applicant or his legal guardian or father & mother BOTH in case of minor child (Left hand T.I. of male and right hand T.I. of female)

Specimen signature or T.I. of the applicant within the two boxes below:
In case change of signatures, kindly make

your old signature here