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/Notary Public on the following points) I . S/o, D/o, W/o Shri residing at ..solemnly affirm as follows: 1. State how and when the passport was lost/ damaged and when FIR was lodged at which Police Station and how many passports were lost/ damaged earlier? 2. State whether you travelled on the lost/ damaged passport, if so state flight number and date and port of entry into India? 3. State whether you availed of any TR.

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