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BIO‐DATA FORM

Name__________________________________________________

Current

address_____________________________________________________________________

Telephone No._______________________________________

Passport No. __________________________________

Date of Issue _________________________________________

Place of Issue _____________________________________

Permanent address____________________________________________________________

Educational Qualifications (please indicate subject in the case of Ph.D.)

Profession ________________________________________________________________

Name & Address of Next‐of‐kin in India ________________________________________

Tel. No. ___________________

Are you married? ______________.

If yes, give below name and address of your wife/husband and children.

 

Are you divorced or separated from your wife/husband? _______________

If yes, indicate below the present status of your wife/husband and who has the custody of the

children.____________________________________________________________________

_______________________

Have you signed any agreement with Government Organization or a University or any public

organization or banks or any other Institution from which you have enjoyed monetary benefit

in the form of passage money, scholarship or otherwise and have specifically or by

implication undertaken to return to India or the amount received? _____________ If yes,

give details on a separate sheet.

Have you been sponsored and provided with certain privileges, such as admission into

colleges, Universities or employment with Government of India/Government of any State in

India? ____________. If yes, give details below.

Have you given any definite undertaking to return to India as a condition of the issuance of

the passport or for the entitlement of some other privileges like scholarship, leave benefits,

etc?_______________. If yes, give details below”.

Is your presence required in India in connection with a civil or criminal

proceedings?______________. If yes, give details on a separate sheet.

Please indicate below the name of the scheme under which you proceeded abroad.

Signature of the applicant

Date:

Place:

______________________________________________

Signature and Seal of Notary Public with date and Seal

AFFIDAVIT

I, __________________________________________ holder of Indian Passport No.

______________________________ dated _________________________________ issued

at ___________________________________________________ expiring on

___________________________ now residing at _________________________________

___________________________________________________________________________

_______________________ hereby declare that

1. The exchange programme was sponsored by the Government of India/State

Government of __________________________________ in India / Agency of the

Government of _________________________________ and financed by the Government of

/ Agencies of the Government of _____________________ / other

______________________________.

2. “I have not signed any agreement/contract with Government of India or a State

Government or Quasi Government Organization or a University or any public organization in

India or any banking or other organization in India by which I have enjoyed any monetary

benefit in the form of passage money, stipend, scholarship, study leave or otherwise, I have

undertaking to return to India after completion of my studies/training in USA.

Or

I took a scholarship/loan of Rs._________________ from (Name of the institution)

______________________ under National Loan Scholarship Scheme or

_____________________________ (any other scheme) during the year ______ , when I was

a student at ______________________ (college/Institution) and I have fully repaid the

amount due from me, or I have yet to repay the amount of Rs. _________________”.

3. I have not taken any loan from any person or agency in India.

4. My presence is not required in India in connection with civil or criminal proceedings.

5. I am unmarried/married and have not deserted my spouse or children in India.

________________________

Signature of the applicant

Date:

Place:

____________________________________________

Signature and Seal of Notary Public with date and Seal

 

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