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Applicants Signature Application For The Grant/Renewal of Pio Card

This document contains a Person of Indian Origin (PIO) card application form for an individual applying or renewing their PIO card at the Indian Consulate in San Francisco. The 29-item form requests basic personal details of the applicant such as name, date of birth, address, nationality, passport information, and details of any family members with Indian citizenship or residency. It includes fields for applicant and witness signatures and declarations that the information provided is accurate. The purpose of the form is to collect necessary information to process a PIO card application or renewal according to the requirements of the Indian government.

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55 views3 pages

Applicants Signature Application For The Grant/Renewal of Pio Card

This document contains a Person of Indian Origin (PIO) card application form for an individual applying or renewing their PIO card at the Indian Consulate in San Francisco. The 29-item form requests basic personal details of the applicant such as name, date of birth, address, nationality, passport information, and details of any family members with Indian citizenship or residency. It includes fields for applicant and witness signatures and declarations that the information provided is accurate. The purpose of the form is to collect necessary information to process a PIO card application or renewal according to the requirements of the Indian government.

Uploaded by

whiteroseswhite
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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1

ConsuIate of India, San Francisco


PIO AppIication Form
HandIed by Indian PIO Center
4239 Geary BIvd,
San Francisco, CA 94118






Paste a
PHOTO here
2 X 2
Applicants Signature

APPLICATION FOR THE GRANT/RENEWAL OF PIO CARD
Note: This application can be used at the Embassy of India, Washington

Sr/No Items
Details
1
Surname (Last Name) - As on current passport
2
First Name - As on current passport
3
Middle Name (If any) - As on current passport
4
Surname at Birth (If any)
5
Other Names / Alias (If applicable)
6
Date of birth (DD/MM/YYYY)
7
Place of birth: (city, state & country)
8
Sex (male/female)
9
Fathers Name & Nationality
10
Mothers Name & Nationality
11
Married /Un-married
12
Spouses name & Nationality (if applicable)
13 (a) Present Address in USA
(b)
Telephone number in USA (reachable, mobile if possible)

(c)
Email address
14 (a) Permanent Address in India (verifiable)
(b)
Telephone number in India
15
Profession/Occupation
16 (a)
Business address
(b)
Telephone number (work place)
2


17
Nationality (at the time of birth)
18
Present Nationality (if different)
19
Date of acquiring present nationality if not by birth

(DD/MM/YYYY)

20 (a)
Passport Number
(b)
Date of issue (DD/MM/YYYY)
(c)
Date of expiry (DD/MM/YYYY)
(d)
Place of issue
21
Does the applicant hold dual nationality? If so, give
details including the details of all the passports held etc.

22
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

23 (a)
Whether the applicant or his/her parents or grandparents
or great grandparents held an Indian passport at any
time, if so details thereof: (enclose photocopy of relevant
documents)

(b)
Passport Number
(c)
Date of issue (DD/MM/YYYY)
(d)
Place of issue
24(a) Whether the applicant or his/her parents or grandparents
or great grandparents was born and was permanently
resident in India as defined in the Government of India
Act, 1935 * at any time {please see instruction (1) }. If
so, following details may be indicated:

(b)
Date of birth (DD/MM/YYYY)
(c)
Place of birth
25
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).

26
Has the applicant ever been refused Indian
passport/travel document or visa for visiting India, if so,
then give complete details: (i.e. place & date of
application, purpose, reasons for refusal etc.)

27
Details of previous PIO Card (If applicable)
(a)
PIO Card Number
(b) Date of issue (DD/MM/YYYY)

(c) Date of expiry (DD/MM/YYYY)

(d) Place of issue

28 (a) Name & complete address of person (1) known to the
applicant living in India or USA telephone number

3


(b) Name & complete address of person (2) known to the
applicant living in India or USA with telephone number

29
Details of fees and mode of payment of fee (Cashier
Cheque/Money order/Postal order/cash); write
number of cashier Cheque/MO/PO if not paid in cash


DECLARATION

I hereby declare that the above statements are true to the best of my knowledge and belief.






Date:
(SIGNATURE OF THE APPLICANT)
In case of minor child, Father should sign the Declaration

Place:

Two specimen signatures of the applicant








** [In case of minor, thumb impression (Left Hand Thumb Impression for male & Right Hand Thumb
Impression for female child is required)]

* * If you are filling application on behalf of your minor child, then childs thumb impressions should be
taken in the boxes given above. If minor can sign, then let him/her do so. Both Parents of minor child
should fill up the declaration given below. If minor could not sign, then in the first declaration minor
applicants parent (mother/father) could sign.



Parents / Legal Guardians Declaration for minor child
We hereby declare that the above statements are true to the best of our knowledge and belief.
Name of the Applicants Father Signature

Name of the Applicants Mother Signature


Date:

Place:

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