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  • AnnexureC CHITTAKSH

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    Satish Mandapeta
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    Deepa Trivedi is applying for a passport for her minor child Chitraksh Trivedi without the consent of the father. She declares that the father is separated from her and his whereabouts are unknown. She affirms that she is solely responsible for the care and custody of the child. Deepa also states that she will be solely responsible for any legal issues arising from issuing the passport without the father's consent.

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    Deepa Trivedi is applying for a passport for her minor child Chitraksh Trivedi without the consent of the father. She declares that the father is separated from her and his whereabouts are unknown. She affirms that she is solely responsible for the care and custody of the child. Deepa also states that she will be solely responsible for any legal issues arising from issuing the passport without the father's consent.

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    27 views2 pages

    AnnexureC CHITTAKSH

    Uploaded by

    Satish Mandapeta
    Deepa Trivedi is applying for a passport for her minor child Chitraksh Trivedi without the consent of the father. She declares that the father is separated from her and his whereabouts are unknown. She affirms that she is solely responsible for the care and custody of the child. Deepa also states that she will be solely responsible for any legal issues arising from issuing the passport without the father's consent.

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    ANNEXURE ‘C’

    SPECIMEN DECLARATION BY APPLICANT’S PARENT OR GUARDIAN FOR ISSUE OF PASSPORT


    TO MINOR WHEN ONE PARENT HAS NOT GIVEN CONSENT

    (On plain paper)

    I/We DEEPA TRIVEDI (name of the parent / guardian applying for passport) resident of 1-58/53,
    FLAT 201, OM JAI SAI SURYA HOMES, MADINAGUDA, HYDERBAD, CYBERABAD 1,
    500049 solemnly declare and affirm as under :-

    (I) That I/we am/are the mother/father/parents/guardians of CHITRAKSH TRIVEDI (name


    of the minor child) who is minor and on whose behalf I/we have made an application for
    his/her passport.

    (II) Signature/consent of Shri/Smt DEEPA TRIVEDI (name of the father/mother) who is the
    father/mother/parents of the child has not been obtained by me for the following one or
    more reasons:-

    (a) The father/mother of the minor applicant is travelling abroad/is on sea/travelling


    in India and unable to file consent; or/and

    (b) The father/mother is separated and no court case is pending before the court
    regarding divorce/marital dispute/custody of the child; or/and

    (c) The father/mother has deserted and the whereabouts are not known; or/and

    (d) There is an ongoing court case for divorce/custody of the minor child and the
    court has not given any order prohibiting the issue of passport without the
    consent of father/mother; or/and

    (e) There is a court order for the custody of the minor child with a parent who is
    applying for the passport and consent of other parent (who has visitation rights)
    is not available or he/she is refusing to give consent/the other parent is not
    availing the visitation rights and his/her whereabouts are not known; or/and

    (f) The parents are judicially separated and custody of the minor child has not been
    defined in the court’s decree; or/and

    (g) The father/mother of……………………..(name of minor child) has deserted me


    after the conception/delivery. That…………………(name of minor child) is
    exclusively under my care and custody since separation/delivery.

    (III) That I/we only am/are taking care of ……………………….(name of the minor child) and
    he/she is exclusively in my/our physical custody.
    (IV) I/we also affirm that in the case of a court case arising due to issue of a passport to the
    minor child ……………..(name of the minor child), I/we would be solely responsible for
    defending the case and not the Passport Issuing Authority.

    Signature of the parent(s)/


    Guardian(s) applying for the Passport
    Place: HYDERABAD

    Date: 15-04-2019

    Name(s): DEEPA TRIVEDI

    Aadhaar Card No: ……………………………….…..; or

    Voter ID Card No……………………………………; or

    Passport no H4177415

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