Precedent No. 79
AFFIDAVIT: LOSS OF PASSPORT
I,…………………………………. ,
S/o……………. ……………………………………………..,
Aged…………………………….. years
presently and permanently
residing in………………………..
do hereby solemnly affirm and declare as follows:—
1……………I was holding a Passport bearing No…………. as issued from the
Regional Passport Office,…………………. on………………………… The expiry date of
my passport was………………………………
- I lost my hand-bag containing the said Passport and other articles in the Central Reference Library of Delhi University on…………………………………………………………………
- An F.I.R. reporting the aforementioned loss was lodged by me with the
……………………………….. Police-station on the very same day. However,
the Police Authorities have been unable to recover my Passport and the accompanying articles till date and I have received no intimation whatsoever from the aforesaid authorities regarding the said loss.
4 I have used my Passport on two occasions – while travelling to Italy
from…………….. to…………………….. , and while travelling to America
from…………… to……………………
- I am a resident Citizen of India.
- As I wish to travel to America next month for the purpose of attending a prestigious conference, I need a Passport as early as possible.
- I undertake to keep the new Passport with utmost care and caution, failing which I will be liable to any legal action, which the Government may be pleased and authorised to take under the Passports Act, 1967.
Sd./ Deponent.
Verification
Verified at………………………………… on this the………………………….. day of ,
20…………….. , that the contents of the above affidavit are true and correct to the best
of my knowledge, belief and information and nothing material has been concealed therefrom.
Sd./ Deponent.
Solemnly affirmed and signed before me by the deponent, who is personally
known to me, on this the……………………….. day of…………… ,20………………
Sd./ Notary.
