Application Form For The Grant / Renewal Of Pio Card Formulaire Pour L'Obtention / Renouvellement De La Carte Pio

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CONSULATE GENERAL OF INDIA
CONSULAT GÉNÉRAL DE L’INDE
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SAINT DENIS, REUNION
(35mm X 35mm)
APPLICATION FORM FOR THE GRANT / RENEWAL OF PIO CARD
FORMULAIRE POUR L’OBTENTION / RENOUVELLEMENT DE LA CARTE PIO
1.
(a) Name of the applicant / Nom du demandeur
……………………………………………………………………………………………..…….…
(b) Surname at birth / Nom de naissance
………………………………………………………………………………………………….…..
(c) Other names (where applicable) / Autres noms (cas échéant)
……………………………………………………………………………………………….……..
(d) Date of birth / Date de naissance
……………………………………………………………………………………………….……..
(e) Place of birth (Town, City, Country) / Lieu de naissance (Département, ville, pays)
……………………………. ; ………………………………….. ; ………………………..………
2.
(a) Father’s name, place of birth & nationality / Nom du père, lieu de naissance & nationalité
................................................................................................................................................................................................
(b) Mother’s Name, place of birth & nationality / Nom de la mère, lieu de naissance & nationalité
................................................................................................................................................................................................
(c) Spouse Name, place of birth & nationality / Nom du conjoint, le lieu de naissance et la nationalité
................................................................................................................................................................................................
3. Address / Adresse : (a) Present / Présente : ………………………………………………………….………………..........
……………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………….……Tel……………………………
(b) Permanent / Permanente : ……………………………………………………………………..…………………………………...
………………………………………………………………………………………………………………………………………..……..…….
……………………………………………………………………………………………………………………Tel……………………………
(c) Address in India (vérifiable) / Adresse en Inde (vérifiable) : ………………………………………….………..……..
………………………………………………………………………………………………………………………………………….………….
…………………………………………………………………………………………………………..….……Tel……………………………
4. Profession or Occupation / Profession ou activité : …………………………………………………..
5. Business/Office address / Adresse du travail/bureau : ………………………………….……………………………….
…………………………………………………………………………………………………………………….Tel ………………………….
6. Sex : Male / Female / Masculin / Féminin : ……………………………………
7.
Marital Status (Married/Unmarried) / Situation familiale (Marié(e) / Célibataire) : ………………..
8. Nationality at the time of birth / Nationalité à la naissance : ……………………………………
9. (a) Present nationality (if different) / Nationalité actuelle (si différente): ………………….……………
(b) Date on which acquired / Date à laquelle elle a été acquise : …………………………………..……..…..

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