Page 236 - STATE v ARIF & ORS. SC-NO-540-2022 PART 1

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. 20. * '~~ ... $ 1811 t til 1B..fllill - •
'• ~tTon or Parent or Guardian if. passport Is lor minor: • · ..
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~ ..m ~ijjfi { $1ili111f ! I mil lJ1I 'lil'f -151 ~ ifilR ~ ~ iRill .,
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I affirm that U,.l)articulars Qiven above are in respect 011 (Name) ....... SJ.I .. ~/n ...... AII\.1!\~ • .C! .... ~~ .fr: ............... :
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801rilau~er'of ....... ~ ~ ~ ~ ............... of wtmm I am lhe Pareni/Guardian. I undertake
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tile entire' responsibility for hislhar expanses. I solemnly declare that h&the has not IOSI, !lllttendeflid of been
deprived of hl&tler citizenshiP of India and !hat lhe lnfOmlatlon giVen In respect Of hlmtler In this app6cation Is
frue. It is also. eartified that the nama of lhe child mentioned Is not Included In Passport of ililhar parent
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--1/' N11111e & SlgnaturBI'T.I. of Parenvauardlan
(Left hand T.l. if male and Right himd T.l. If female)
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- ~, Place. ............................. ~toate ~V~4,~r ..
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M lf'r.l ~ \I!Jl1l t. Enclosures : ~,.. ~ at Y
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Particulars of person to be inlimatad in lhe avant ........... nT''·'",...., ...... 'IT'"''~·~;,; \\Ott o
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fcer.i\1\'\~·~o>~:'t.~ ... .":': ...... ~si~~~~~!g?<
of delllh or ac:oident: . .
'IP!tHiltne .. : ..... t.l.i;Y-f!:l-... !l ll:M.P.I.b .. ~i\:~,~. J- IS.:! ............................................... ~~.~
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'IIIII Address ..... ~liiab~:t! .. P..~.t.P.:.~ .. IM~.~ -~
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•••••••••••••••••••••o-o••••••••••o•otuoo•••••<oo•oonoo ............................................................ , ... ~., .... ,,,. ..
~ Talaphone Number.................................... . ..................................................................... , ....... .
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23. aM~~~ #I • m il aet IQ:ll ~ ~ R~ <lf'lil ~ * 1lmR * tool~ 'llfl t 1
/ . Specimen &ign~1116 or Thumb Impressions of appll:,"~~s giVen below AND· on twO stickers •
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