Instructions for filling the Affidavit

(For Status)








1. Witness should be:
a. Valid Indian Passport holder
b. Valid Green Card holder
c. Should not be a citizen of America

(Copies of (a) and (b) documents should be
notarized by Notary Public and submitted along
with the affidavit)

2. N/A should not be written anywhere. Complete and
correct information should be provided.

3. The affidavit, once completed, should be notarized
by Notary Public








AFFIDAVIT


I, (name),_______________________________________________________________,
Son of__________________________________________________________________,
Residing at______________________________________________________________
_______________________________________________________________________,
Date of Birth_____________, being an applicant for Issue of passport, do hereby
solemnly affirm and state as follows:


1. That the names of my parents and spouse are as follows (indicate full name);
i. Father:
ii. Mother:
iii. Wife/Husband:

2. That I am continuously residing at the above mentioned address from
_________________ (Date).

3. That I am a citizen of India by birth/descent/registration/naturalization and that I have
neither acquired the citizenship of another country nor have surrendered or been
terminated/deprived of my citizenship of India.

4. That I came to the USA illegally/legally on __________________.

5. That I do not have any legal status in the USA/I have legal status in the USA. (Please
mention the nature of status)______________________________________________
_____________________________________________________________________

6. Neither I, nor any of my family members have applied for obtaining political asylum
in the USA or any other country. (Clearly indicate here if you or any of your family
members have applied for political asylum in the USA)________________________
_____________________________________________________________________

7. That I have not, at any time during the period of five years immediately preceding the
date of this affidavit, been convicted by any court in India for any offence involving
moral turpitude and sentenced in respect thereof to imprisonment for not less than
two years;

8. That no proceedings in respect of any criminal offence alleged to have been
committed by me are pending before any criminal court in India.

9. That no warrant of summons for my appearance, and no warrant for my arrest, has
been issued by a court under any law for the time being in force, and that my
departure from India has not been prohibited by order of any such court.


10. That I have never been repatriated from abroad back to India at the expense of
Government of India, but reimbursed expenditure incurred in connection with such
repatriation___________________________________________________________.

11. That I will not engage in activities prejudicial to the sovereignty and integrity of India

12. That my presence outside India will not prejudice the friendly relations of India with
any foreign country.

13. I am holder of Indian Passport No.____________ Issued at ____________________,
on_____________________, valid until____________________________________.

14. I could not apply for renewal/reissue of my passport in the prescribed period due
to___________________________________________________________________
_________________________________________________(Please state the reason)

15. Issue of passport/extension of validity of existing passport will facilitate in
regularization of my stay in the US. All efforts are being made by me to get my stay
regularized.

16. I hereby undertake and agree that if the short validity passport issued to me is lost, I
would not be granted further passport facilities and instead one way emergency
certificate would be issued to me.



Place: ___________________
Date: ___________________

Deponent




Witness 1


Signature________________________
Name ________________________
Address ________________________
________________________
Witness 2


Signature________________________
Name ________________________
Address ________________________
________________________