TO BE SUBMITTED WITH THE APPLICATION FOR A PASSPORT OF A MINOR CHILD BY
EITHER PARENT (WHO ARE SEPARATED BUT NOT FORMALLY DIVORCED) OR BY A SINGLE
PARENT OF THE CHILD BORN OUT OF WEDLOCK
(To be executed on non-judicial stamp paper)
I, (name of single parent)
solemnly declare and affirm as follows:
That I am the mother/father of (name
of the child) who is a minor child and on
whose behalf I have made an application for his/her passport.
That I am judicially separated from the mother/father of
(name of minor).
That no legally valid marriage
ever existed between me and Mr./Ms.(the
father/mother the minor
The father/mother of (name of the child) has deserted me after conception/
That (name of the minor) is exclusively under my care and
custody since separation/delivery.
& address of Deponent
before the First Class Judicial Magistrate or Notary Public)