APPLICATION FORM FOR THE GRANT/RENEWAL OF A PERSON OF INDIAN
                    ORIGIN (PIO) CARD (TO BE FILLED UP IN DUPLICATE)

                                                            Affix passport size
                                                            photograph

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 : (town, city,country):_________________________________________________

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. Martial 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 which issued the passport: ____________________________________________________

(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 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 an Indian passport at any time, if so details thereof:

(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 grant parents
    or great grand 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 sponse 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 complete 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 address 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 of fee : _________________________________________________
        
        Contact Telephone No:
 

DECLARATION

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 documents substantiating your claim as
a person of Indian origin. (Please also see cols. 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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· Expression 'India' as given in sub-section (1) of the section
311 of the Government of India Act, 1935 means
British India together with all territories of any Indian Ruler
under the suzerainty of His Majesty, all territories under the
suzerainty of such an Indian Ruler, the tribal areas, and
any other territories which His Majesty in Council may,
from time to time, after ascertaining the views of the Federal
Government and the Federal Legislature, declare to be part
of India.

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SPECIMEN SIGNATURES: