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ANNEXURE – I

BEFORE THE NOTARY PUBLIC,

AFFIDAVIT

I, MOHIT RASTOGI son of SRI SATYA DEV RASTOGI, husband of RACHNA


RASTOGI residing at 3/78 GUJARAT REFINERY TOWNSHIP PO JAWAHAR
NAGAR, VADODARA- 391320 in the district of VADODARA (GUJARAT) Date of
Birth 01/01/1974 being an applicant for issue of Passport, do hereby solemnly
affirm and state as follows:

1. That the names of my parents are as follows:

(i) Father : SRI SATYA DEV RASTOGI


(ii) Mother :SMT VIMLA RASTOGI
(iii) Husband :
(iv) Wife : RACHNA RASTOGI

2. That I am continuously resident at the above mentioned address from


MAY 2015.

3. That I am citizen of India by birth and that I have neither acquired the
citizenship of another country nor has surrendered or been terminated /
deprived of my citizenship of India.
Contd……….P1 /2
[2]

4. That I have not, at any time during the period of 5 years immediately
preceding the date of this affidavit, been convicted by any court in India
for any offence involving moral turpitude and sentenced in respect
thereof to imprisonment for not less than two years.

5. That no proceedings in respect of any criminal offence alleged to have


been committed by me are pending before any criminal court in India.

6. That no warrant or summons for my appearance, and no warrant for my


arrest, has been issued by a court under any law for the time being in
force, and that my departure from India has not been prohibited by order
of any such court.

7. That I have never been repatriated from abroad back of India at the
expenses of Government of India. I was repatriated from abroad back to
India at the expenses of Government of India, but reimbursed
expenditure incurred in connection with such repatriation.

8. That I will not engaged outside India in activities prejudicial to the


sovereignty and integrity of India.

9. That my departure from India will not be detrimental to the security of


India.

10. That my presence outside India will not prejudice the friendly relations of
India with any foreign country.

Place : Vadodara
Date :
DEPONENT

VERIFICAITON

Verified on _____ day of _____________ 2018 at Vadodara that the


contents of the above mentioned affidavit are true and correct and
nothing material has been concealed.

Identified by me.

Advocate

(DEPONENT)
Solemnly affirmed and declared before me by the deponent
who is being identified by ____________________________,
Advocate, on this _______ day of _____ 2018 at Vadodara.

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