Application form for Indian Passport & Misc. Services


1.	1.1 Name of the applicant	_________________________________________________
	1.2 Surname at birth (if different)	_________________________________________________
	1.3 Other names (if applicable)	_________________________________________________
	1.4 Date of birth	_________________________________________________
	1.5 Place of birth: (town, city & country)	_________________________________________________

2.	Family Details: 2.1 Father's Name & Nationality	_________________________________________________
	2.2 Mother Name & Nationality	_________________________________________________
	2.3 Spouse Name & Nationality	_________________________________________________

3.	3.1 Present Address	_________________________________________________
	3.2 Permanent Address	_________________________________________________
	3.3 Address in India (verifiable)	_________________________________________________

4.	Profession or Occupation	_________________________________________________
5.	Business/Office Address	_________________________________________________
6.	Sex	Male / Female ________________________
7.	Marital status	Married/Unmarried _____________________________
8.	Nationality (at the time of birth) :	____________________________________
9.	9.1 Present Nationality (if different) :	____________________________________
	9.2 Date on which acquired	____________________________________
10.	Passport particulars of applicant
	10.1 Visible Distinguishing Marks	____________________________________
	10.2 Passport Number	____________________________________
	10.3 Date of issue	____________________________________
	10.4 Date of expiry	____________________________________
	10.5 Country which issued the passport	____________________________________
	10.6 Place of issue	____________________________________
11	Does the applicant hold dual nationality : (If so, 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 an Indian passport at any time, if so details thereof: (enclose photocopy of relevant documents)
	13.1 Passport Number	_________________________________________________
	13.2 Date of issue	_________________________________________________
	13.3 Please of issue	_________________________________________________
14	Whether the applicant or either of his/her parents or any of his/her grand 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 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 complete details: (i.e. place & date of application, purpose, reasons for refusal etc.)	_________________________________________________ _________________________________________________

16.	Details of previous PIO Card (if applicable)
	16.1 Date of issue	_________________________________________________
	16.2 Date of expiry	_________________________________________________
	16.3 Place of issue	_________________________________________________

17.	Name & complete addresses of two persons known to the applicant living in India
	17.1 Name	_________________________________________________
	17.2 Full postal address	_________________________________________________
	17.3 Contact Phone No.	_________________________________________________

18.	Details and mode of payment of fee	_________________________________________________


	Space for additional Information if any you would like to give: ____________________________________________________________________ ____________________________________________________________________

	DECLARATION : I hereby declare that the above statements are true to the best of my knowledge & belief.
Place: ________ Date: _________	_____________________________________________ Signature of the applicant
	_____________________________________________ _____________________________________________ Two Specimen signatures of the applicant

	NOTE: 1) Please attach relevant documents substantiating your claim as person of Indian origin. 2) Original Passport and Photocopy of Birth Certificate required. 3) Attach 4 recent passport size photographs. 4) Attach self addressed courier envalope to return your passport. 5) Furnishing of false information will result in summary rejection of the application. 6) Acceptance of application forms does not confer any right on the applicant to the PIO card. 7) Registration with FRRO/FRO required if continous stay in India exceeds 180 days. 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.