<p> Assistant High Commission of India Mombasa</p><p>Application for Miscellaneous Services</p><p>1. Name :</p><p>2. Father’s/Husband’s Name :</p><p>3. Date of Birth : Place of Birth :</p><p>4. Permanent Address in India, if any:</p><p>Tel No. </p><p>5. Present Address in Kenya:</p><p>Tel No. </p><p>6. New Address : (if application is for change of address)</p><p>7. Details of current passport: Passport No. : Date of Issue :</p><p>Place of Issue : Valid Until :</p><p>8. Service Required: Please tick and strike out the others:</p><p> a. Attestation of Affidavit b. Authentication/attestation of documents c. Power of Attorney d. Change of Address e. Police Clearance Certificate (for: please write name of country) f. PIO Endorsement</p><p>9. Please attache: copy of passport, all documents, in duplicate, copy of PIO or OCI card, if any, and one extra photograph</p><p>Date: ______T.I. or Signature of Applicant ------For official use: Receipt No. Amount Ksh: ______Date Given:______</p><p>Misc. Service No. ______Dt. ______Initial of Counter staff</p>