FORM P4
Form of Emergency Certificate
(Front Cover)
Government of India
Emblem
Emergency Certificate
(Page No. one)
Emblem
Emergency Certificate

No.
This is to certify that ____________________________________________________
________________________________________________________________

_____________________________________
has applied to me for the grant of an Emergency Certificate and that I have no reason to

doubt his/her statement.

 

                                                 Signature of issuing Authority_______________
                                       Date____________________________________
(Page No. Two)
No.                 
Description
(a)  Profession________________________________________________ 
(b) National Status______________________________________________
(c) Father’s/Husband’s name______________________________________
(d) Place and date of birth________________________________________
(e) Address in India_____________________________________________
(f) Visible distinguishing marks, if any______________________________
(g) Height_____________________________________________________
(h) Colour of hair_______________________________________________
(i) Colour of eyes_______________________________________________
(Page No. Three)
No.
The holder is accompanied by a-child/ children whose Particulars are shown below:
Particulars of child/children
S.            No. Name                Date of birth                              Sex
1.         _____________________________________________________________
2.         _____________________________________________________________
3.         _____________________________________________________________
4.         _____________________________________________________________
 

Signature of a bearer_____________________________

__________________
(Page No. Four)
No.
___________________________________________________________________
This certificate is only valid for journey to _________________________________
___________________________________ Via ____________________________
___________________________________________________________________
Unless renewed the validity of this certificate expires on ______________________
___________________________________________________________________
Renewed up to ______________________________________________________
Date _______________________________________________________________
(Page No. Five)
No.
VISAS
(Page No. 6)
No.
VISAS
`N.B.-The possession of this Emergency Certificate does not exempt the holder from compliance with any immigration regulations in force in the country of destination or from the necessity of obtaining a visa where required.