ANNEXURE C

I, SHABNAM ABDUL RAZAK SHAIKH, solemnly declare and affirm the following: 1. That I am the mother of FARHAN PATNI (name of the child), who is a minor and on whose behalf I have made an application for his passport. 2. That no legally valid marriage ever existed between me and Mr. FARUKH PATNI. 3. That FARHAN PATNI is exclusively under my care and custody since separation/delivery.

Date: 15/01/2014 Signature of Deponent: ________________________ Address of Deponent: Room No. C-10, Building No. E1-30 Sahyog Apartments, Sector 10, Nerul, Navi Mumbai 400706.