Page 235 - STATE v ARIF & ORS. SC-NO-540-2022 PART 1

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.. 16. ~tR •• 11111
·~~ Indicate whelher:
~
~·'f (0 ~ 311'118 ~I '!a! ~ ~ 'I'll f!l;lrr "''ll Ill Ill 1't ';!1ft f<;;>n 1fllf 'IT 3W<II 1i Ovea
• Tid <l'lllt 1111151 10 ..,. till
(i) A paaspoMravel document was refused/impounded at any Ume or restored lll 0 No
condlllonally.
•
(il) -~~ 'Iii lMI8 1ll'R! 'R bl wi4iilfia l!Fu 1liiJ 111 11 Yes
,!Ill ,. Applicant was repatriated at Government coaL No
bii) 1l'll .. 111'4. '1m! JR<II6 fil;ln 1liiJ Ill
•
Yes
(iii) The applicant was ever deported to India.
No
11. 'lTQ<ITt ~. 1967 10 tiiRI 6 ill """" ~ 1iiFFiiiO
Information required u~der section 6 of the Passport Act. 1967
~ it w ~ ~
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(I) 11111 • ~ * * • ~ '14 ~ - ill • 8
1111
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fililll 1f'l'f -.rmr • M -.a'lR'I'f Sill ~ ~ -qt111 1fllf 111 - lf>1'U\mt 1111 ·~ .~t
'If Ill? er Vas
J:
(') Has the appliCant at any Urne during the period or five years Immediately 'Iii N~ov
prtceding the date or this application been convicted by a CO\Irl in lnclla lor any ~
/
criminal offence and sentsnced to imprisonment? ' '"i(l .,:.u~ ,.,cf!!.
• £,\y "a>P'- tL Q\•
(ii) 11111 '1m! It fliAII ~ ~ ~ fc(q_ ~ ~ 181 t? -~
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it
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111ft
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(II) .\ra ~Y criminal proceedings pending against the applicant before a p.s51f'l ,~f->~ 1
(110 w'M "'ml''11U ~ ~ ~ ~ ~ m1!fl fiRw6 iS ~ I'IIRII il; • 8 , .,.., •.
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mutt •n India?
;m
il
1liR ~ JIRlf ill 3llbr 1118 ~ ~ t? ? ~ Vee
-(iii) Has a warranl or summons for. appearance or ·.arrant fer arrest or an 01der "1111 No
prohibiting the applicant's departure 'from India been issued by a murt?
18.~.a ~.
DECLARATION OF .APPUCANT:
, 'lR1I ,. •· ~ afll 3IIRm q; 'll1ll f.lil ~ am ill~ n t ~ 3PI br .. ~ ~ 11m ~ '181
111'!1
M t I - - 'Ill ~ 'lftill1'l 'I tilt, 'I 'dl 'lil 11\'111 1lflr.r lif;>n 11111 • I \. ·
1 owe allegiance to tile sovereignty, unity & integrity of India and have not volulllarily acquired the
cltlzenshlp or lrevel document of another country. I hdve not lost. surrendered or been deprived of
citizenship of India.
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~ 1!11 ~ ~ llf t Rt '8t'lllit tl\'llll ~ r,.Q 4 '1.3 1Rl! ~ ~ ~ t\'1 qa • ~ ~I~
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t ~if~~ ~I'§IIR! iml\1 tt .
The information given by me Is true and I .. m solely responsible
offence under the Passports Act 1967 to fumish any lafse
Information with a viaw •. l~iflg "i)i:iisli'~~;,r.;IIIP~·IIil
'RIIW~ 'li f1nlR
Sig:nature/Thumb Imp assion of applicant
B I Oate. .... y_....... lllf'l/ Place. .......... ~ . .O.. ..... .
~
~
19. ~ ftoqfll if 11R11tlir.n ~ 'lit ~ f!R!am liiR'Rfl il1
In case of minors, following pa~•:XIrl ~articu·ars of both parents must ba given:
lll1' 1 Mother ~/FatMr
(a) ~ Passport No.: ......................................... . . ........................................ .
;%-
1
. .......................................... .
(b) 0118 ~ 'It 'iiRlw I Dats of Issue· · . ...... ~ ................................. . ••
(c) IIIli! ~ 1(;1 11IR 1 Place of Issue: .......................................... . .. ....................................... r
, \\(b)
- _ .. .

•