Additional Particulars Form (For Visa/oci/pio Card Services) - Conlin Travel Page 3
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1
2
3DECLARATION
I hereby declare that the above particulars are true.
I also agree that in
case any false information is given in the above form, appropriate action as
per Government of India rules and regulations may be taken against me,
including but not limited to revoking of issued Visa/OCI/PIO card and any
other action as deemed fit by the Government of India or its agencies.
I am applying for Visa / OCI / PIO card (select whichever not applicable)
(a) As a spouse of an Indian origin person
(b) Not as a spouse of Indian origin person.
In case of (a), I undertake to intimate the Consulate immediately about the
dissolution of such marriage, if it occurs.
Date:
Place:
(Signature of the Applicant)
Please note: In case of minor child, both parents / legal
guardian should sign the declaration
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