EMBASSY OF INDIA,______________________________
HIGH COMMISSION OF INDIA,______________________
CONSULATE GENERAL OF INDIA,___________________
    1.     (a) Name of the applicant :
            (b) Surname at birth (if any) :
            (c) Other names (where applicable) :
            (d) Date of birth :
            (e) Place of birth :
  2.    Father's/Mother's/Spouse's name & Nationality :
            (a)  Father :
            (b) Mother :
            (c) Spouse (where applicable) :
    3.     Address :  (a) Present :
                            (b) Permanent :
                            (c) Address in india (verifiable) :
    4. Profession or occupation :
    5. Business / Office address :
    6. Male / Female :
    7. Marital Status :     Married / Unmarried.
    8. Nationality (at the time of birth) :
    9.     (a) Present nationality (if different) :
            (b) Date on which acquired :
    10. Passport particulars of applicant :
            (a) Passport Number :
            (b) Date of issue :
            (c) Date of expiry :
            (d) Country of expiry :
            (e) Place of issue :
    11. Does the applicant hold dual nationality :
        (if so, please give details including the details of all the passports held etc.)
    12. Did the applicant at any time held the nationality of any country other than the present nationality,             if so please give details including the period :
     13. Whether the applicant or either of his/her parents or grand parents or great grand parents held              and indian passport at any time, if so details there of :
            (a) Passport Number :
            (b) Date of issue :
            (c) Place of issue :
            (d)  Date of expiry :
            (enclose photocopy of relevant documents)
    14. Whether the  applicant or either of his/her parents or any of his/her grand parents or great grnad             parents was born and was permanently resident in india as defined in the Government of India             Act, 1935 at any time. If so, following details may be indicated :
            (i)  Date & Place of birth :
            (ii) Proof of residence etc :
            (enclose photocopy of relevant documents)
           (Note : If applicant is the spouse of a citizen of India or a person of Indian origin, his/her                particulars should be indicated);
    15. Has the applicant ever been refused Indian passport/travel document or visa for visiting India, if so,             give complite details : (i.e. Place & date of application, purpose, reasons for refusal etc.)
    16. Details of previous PIO Card (Wherever applicable ) :
        (a) Date of issue :
        (b) Date of expiry :
        (c) Place of issue :
    17. Name & complete addresses of two persons known to the applicant living in India :
        (a) Name :
        (b) Complete postal address :
        (c) Telephone No :
    18. Details and mode of payment
I hereby declare that the above statements are true to the best of my knowledge and belief .**
                                                                                    Signature of the applicant.
Two specimen signature of the applicant :
1. Please enclose all relevant documets substantiating your claim as a person of Indian origin. (Please also see Col. 13 and 14)
2. Attach 4 recent stamp size photographs.
** Furnishing of false information will result in summary rejection of the application.
Note : Acceptance of application form does not confer any right on the applicant to the PIO Card.



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