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ENCLOSURE TO G.C.B. & C.D. NO. GEM/1181/12067/1/G
DECLARATION
I Shri __________________________________ wori!" as _________#$%&''( )*
A+ #O,,i$- N&.- & A/r--') state that, I intend to go abroad. I hereby declare that if I fail
resume my duties at Gujarat Maritime Board under the Chairman of Gujarat Maritime
Board, immediately after the expiry of the period of leave that may be granted to me.
This declaration shall be considered as my resignation from Government service and
the Government may proceed further as if I have resigned on Government servant.
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ANNE7TURE8A
EM9LO:EE;S DETAIL 5OR RENE<AL/NE< 9ASS9ORT

$mp.name
%ather name
$mp.son name
$mp.daughter name
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$mp.no.
'$ncl. (assport si)e photographs * nos.+
GOVRNMENT OF INDIA

MINISTRY OF EXTERNAL AFFAIRS
CPV DIVISION, DELHI
ANNEXURE B
ALL CENTRAL GOVERNMENT EMPLOYEES STATE GOVERNMENT EMPLOYEES,
EMPLOYEES OF STATUTORY BODIES AND PUBLIC SECTOR UNDERTAKINGS AND
THEIR DEPENDENT FAMILY MEMBERS ARE REQUIRED TO PRODUCE A IDENTITY
CERTIFICATE (STRIKE OUT PORTION NOT APPLICABLE)
(To be given in Duplicate on Original Stationery)
Certified that SHRI _________________________ Son of Shri ____________________
is a temporarypermanent employee of this (office address) from Date ! """""""""" and
is at present holding the post of """"""" ShriSmt#iss#st$%%&%'$$%% isare a
dependent family member(s) of ShriSmt$%&%'$$% and hisher identity is certified% This
#inistryDepartmentOrgani(ation has no ob)ection to hisher ac*uiring Indian +assport%
The undersigned is duly authori(ed to sign this Identity Certificate% I have read the
provisions of Section ,(-) of the +assports 'ct. /0,1 and certify that these are not attracted
in case of this applicant% I recommend issue of an Indian +assport to himher% It is certified
that this organi(ation is a central State 2overnment +ublic Sector underta3ing
statutory body% The Identity Card &umber of SHRI ____________ (employee) is """"""""%
Ref% &o% 4
Date $$$$$%% &ame. Designation. address 4 Tel &o%

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ANNEXURE I
AFFIDAVIT
I. name). ___________________________ Son of SHRI __________________________ residing
at _______________________________% Date of 5irth _______________ being an
applicant for issue of passport. do hereby solemnly affirm and state as follo6s!
/% That the names of my parents and spouse are as follo6s!
(i) 7ather !
(ii) #other ! S.+.
(iii) 8ifeHusband ! S.+. _________________
-% That I am continuously resident at the above mentioned address from
_____________.
9% That I am citi(en of India by birthdescentregistrationnaturali(ation and that I have
neither ac*uired the citi(enship of another country nor have surrendered or been
terminateddeprived of my citi(enship of India%
:% That I have not. at any time during the period of five 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 t6o
years%
;% That no proceedings in respect of any criminal offence alleged to have been committed
by me are pending before any criminal court in India%
,% That no 6arrant or summons for my appearance. and no 6arrant for my arrest. has
been issued by a court under any la6 for the time being in force. and that my departure
from India has not been prohibited by order of any such court%
1% That I have never been repatriated from abroad bac3 to India at the e<pense of
2overnment of IndiaI 6as repatriated from abroad bac3 to India at the e<pense of
2overnment of India. but reimbursed e<penditure incurred in connection 6ith such
repatriation%
=% That I 6ill not engage outside India in activities pre)udicial to the sovereignty and
integrity of India%
0% That my departure from India 6ill not be detrimental to the security of India%
/>% That my presence outside India 6ill not pre)udice the friendly relations of India 6ith any
foreign country%
+lace! """"""""""
Date , ---------- DEPONENT
VERIFICATION
?erified on __________ (date) at _________ (place) that the contents of the above
mentioned affidavit are true and correct and nothing material has been concealed%
DEPONENT
SURIT: BOND 5ROM 9ERMANENT GO=ERNMENT SER=ANT
I Shri __________________________ at present &or.ing as ______________ in the
GMB , G/012I0/G/3 office, do here by find myself, my heirs, successors, executor
and assigns to the Chairman of Gujarat Maritime Board '2ere in after called the
Government &hich expression shall unless other&ise admits, includes his successors
and assigns+ and underta.en that in case of failure in payment of instalments of 2ouse
Building /dvance by Shri _________________________________ at present &or.ing
as ______ 'hereinafter referred to as the 4Borro&er5+ &ho proceeds to foreign countries
I shall pay all those monthly instalments of 2ouse Building /dvance due from the
Borro&er till he resumes his duties after return from the foreign countries.
I do hereby give my consent for recovery of these remaining monthly instalments from
my monthly salary till the amount due as fully recovered or till the Borro&er resumes his
duties after returning from foreign countries &hichever is earlier. In &itness of I
hereunder to set my hand on this day ------------, signed and delivered by above
named.
In presence of
'#+ 6ignature
1ate , !"#!
0ame and 1esignation of 7ffice
to &hich attached
'!+ 6ignature
1ate , !"#!
0ame and 1esignation of 7ffice
to &hich attached
6ignature of 6urety
/ccepted by
%or and on behalf of the
Gujarat Maritime Board
NAME 0_______________
D-'i"!&+io!0 ----------
Gujarat Maritime Board

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