Form 2

Embassy of India
Riyadh

Application for Miscellaneous Services Please affix one

Photo
1. Name :

2. Father’s/Husband’s Name :

3. Date of Birth : Place of Birth :

4. Permanent Address :

Tel No.

5. Present Address in KSA :

Tel No.

6. New Name :
(if application is for change of name)

7. New Address : (if application is for change of address)

8. Details of current passport :

Passport No. : Date of Issue :

Place of Issue : Valid Until :

Details of previous passport :

Passport No. : Date of Issue :

Place of Issue : Valid Until :

9. Service Required : Please tick and strike out the others.

a. Renewal upto full validity [Photo is to be affixed for
b. ECNR Stamp (a)(if passport is not issued
c. Inclusion of spouse’s name from Riyadh, (e) and (f)]
d. Change of Name/Maiden Name
e. Police Clearance Certificate (for : please write name of country)
f. Change of Address
g. Any other – Please specify :

____________________________________________
Signature of Applicant

For Official Use Only No. RIY/C/

To : PASSEM/HICOMIND/INDEMBASSY/CONGENDIA

Please confirm/verify the passport particulars/new address mentioned above in order to enable us to
render the requested service.