ANNEXURE ‘D’
SPECIMEN DECLARATION BY APPLICANT’S PARENT(S) OR GUARDIAN FOR ISSUE OF
PASSPORT TO MINOR
(On plain paper)
I/we IMTIYAJ HARUNBHAI SADEKI resident of RANGMATI SOCIETY, KALAVAD NAKA BAHAR, HAPA ROAD,
JAMNAGAR, GUJARAT -361001 hereby affirm that the particulars given below are of we NUZHAT SADEKI
(name of the child), son/daughter of Shri IMTIYAJ HARUNBHAI SADEKI and Smt PARVINBEN IMTIYAZ SADEKI of
whom I/we am/are the parents /guardian.
1. Particulars of minor child
Name: NUZHAT SADEKI
Date of birth: 15/11/2009
Place of birth: JAMNAGAR.
2. The minor child mentioned above is a citizen of India.
3. I/We undertake the entire responsibility for his/her expenses.
4. I/we solemnly declare that he /she has not lost, surrendered or been deprived of his/her citizenship of
India and that the information given in respect of him/her in this application is true.
5. It is also certified that I/we am/are holding /not holding valid India passport(s).
Place: JAMNAGAR Date: 29/10/2024
Signature of father Signature of mother
Passport No.: …………………………..or Passport No X8053543 or
Aadhaar Card No.: 5333 9085 0428 or Aadhaar Card No. 7753 6906 3461 or
Voter ID Card No.:………………………………... Voter ID Card No.: ……………………………..…
Signature of legal guardian(s)
Passport No............................................................... or
Aadhaar CardNo ...................................................... or
Voter ID Card No.: …………………………………
