FORM EA (P) 5
Application for the issue of certificate of identity
(This application must be accompanied by three passport size photographs one duly attested by local police authority - and residential permit.
I. Fee
1. Amount.
2. Date of payment.
3. Mode of payment.
II. Personal particulars:
1. (a) Full name (in block letters).
(b) Aliases, if any (in block letters).
2. Previous name if you have ever changed your name.
3. Maiden name in case of a married woman/widow/divorcee.
4. Father’s name.
5. Husband’s name in case of a married woman/ widow /divorcee.
6. Last permanent address abroad.
7. Present address.
8. Place/Country of origin.
9. Present national status.
10. Period of residence in India.
11. Profession.
12. Place of birth.
13. Date of birth.
14. Height.
15. Colour of eyes.
16. Colour of hair.
17. Visible distinguishing marks, if any.
III. Particulars of child/children below 15 years of age, to be included in the certificate of identity:
Name |
Date of birth |
Place of birth |
Relationship |
1. |
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2. |
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3. |
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4. |
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IV. 1. Purpose of applying for the certificate of identity:
2. Countries for which the certificate of identity is required
V. Declaration of applicant:
I solemnly declare that-
(a)I am of------------------------------- nationality/Stateless.
(b) I have not obtained an Indian/foreign travel document before
because--------------------------
(c) The information given by me in reply to the question in this form is true.
Place------------------
Date------------------
Signature or thumb-impression (left in case of a male and right in case of a female) of the applicant.
Two specimen signatures or thumb-impressions (left in case of a male and right in case of a female of the applicant.
