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 !)
"eference #u$ber
Verificati! Certificate
This is to certify that Sh%&S$t%&'u$% ((((((((((((((%%%%%%%%%%%%% son&wife&daughter of
(((((((% whose personal particulars are given below) has good $oral character and reputation and that
after having read the provisions of Section *(+) of the ,assports Act) -.*/) certify that these provisions are not
attracted in case of this applicant and ) reco$$end issue of an ndian ,assport to hi$&her% Applicant has been
staying at his&her address continuously for the last one year%
Date of 0irth ((((((((((((%%
,lace of 0irth ((((((((((((%%
1ducational 2ualification ((((((((((((%%
,rofession (3ovt%&,rivate Service&Others) ((((((((((((%%
,er$anent Address ((((((((((((%%
,resent Address ((((((((((((%%
,lace
Office Address with location
Date4 Signature (((((
5ull #a$e ((((((((%
Designation (((((((%%
6ard #o% ((((((((%%
(1nclose a photocopy of 6ard)
Telephone #o%
(O)(((((%
(")((((%%
7obile #o((((((
Office Seal
Applicant8s ,hoto
Nte"#
-% The applicant8s passport si9e photograph is also re:uired to be affixed on the ;erification 6ertificate
and attested by the officer issuing the ;erification 6ertificate with his&her signature and rubber sta$p
put in such a way that half the signature and sta$p appear on the photograph and half on the certificate%
+% f the applicant has resided at $ore than one place during the last one year) then all previous addresses
with the relevant dates should be $entioned%
<% This ;erification 6ertificate $ay be got signed by any of the following4
(i) An =nder Secretary& Deputy Secretary& Director& >oint Secretary& Add% Secretary& Special
Secretary& Secretary&6abinet Secretary to 3overn$ent of ndia
(ii) A Director&>oint Secretary&Additional Secretary&Special Secretary&6hief Secretary to a State 3ovt%
(iii) A Sub?Divisional 7agistrate&5irst class >udicial 7agistrate&Additional D7&District 7agistrate of
the district of residence of applicant%
(iv) A District Superintendent of ,olice) D3&3&D3, of the district of residence of applicant%
(v) A 7a@or and above in the ar$y) At% 6o$$ander and above in the #avy and S:% Aeader and above in
the Air 5orce
(vi)The 3eneral 7anager and above of a ,ublic Sector =ndertaBing
(vii) All $e$bers of any All ndia Service or 6entral Service who are e:uivalent to or above the ranB of
an =nder Secretary to the 3overn$ent) i%e% with 3rade pay of "s%*)*CC&? and above%
(viii) "esident 6o$$issioners&Additional "esident 6o$$issioners of all State 3overn$ents based in
Delhi%
(ix) 6oncerned Tehsildars or concerned SDOs for an applicant staying in the area under his&her
@urisdiction%
(x) The 6hair$en of the Apex 0usiness Organi9ations) i%e% 566) 6 and ASSO6DA7 in respect of
owners) partners or directors of the co$panies that are $e$bers of the concerned 6ha$ber in prescribed
perfor$a as at Annexure >!% (The certificate should specify applicant is a owner& partner& director of the
co$pany)
E% Anyone who issues incorrect verification certificate $ay be prosecuted under section -+(+) of the
,assports Act) -.*/%
F% S16TO# *(+) (6) O5 TD1 ,ASS,O"TS A6T) -.*/ ?
Sub@ect to the other provisions of this Act) the passport authority shall refuse to issue a passport or
travel docu$ent for visiting any foreign country under clause ( 6 ) sub?section F of any one or $ore of
the following grounds) and on no other ground) na$ely4(a) that the applicant is not a citi9en of ndia%
(b) that the applicant $ay) or is liBely to) engage outside ndia in activities pre@udicial to the sovereignty
and integrity of ndia%
(c) that the departure of the applicant fro$ ndia $ay) or is liBely to) be detri$ental to the security of
ndia%
(d) that the presence of the applicant outside ndia $ay) or is liBely to) pre@udice the friendly relations of
ndia with any foreign country%
(e) that the applicant has) at any ti$e during the period of five years i$$ediately preceding the date of
his application) been convicted by a court of ndia for any offence involving $oral turpitude and
sentenced in respect thereof i$prison$ent for not less than two years%
(f) that cri$inal proceedings in respect of an offence alleged to have been co$$itted by the applicant
are pending before a court in ndia%
(g) that a warrant or su$$ons for the appearance) or a warrant for the arrest of the applicant has been
issued by a court under any law for the ti$e being in force or that an order prohibiting the departure
fro$ ndia of the applicant has been $ade by any such court%
(h) that the applicant has been repatriated and has not rei$bursed the expenditure incurred in connection
with such repatriation%