Application Form For The Grant Renewal Of Pio Card (Page 3 of 3) in pdf

Application Form For The Grant Renewal Of Pio Card Page 3

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16.

Details of previous PIO Card:

a) Date of Issue:

__________________________________________________________

b) Date of expiry:

__________________________________________________________

c) Place of issue:

__________________________________________________________

17.

Name and complete address of the two persons known to the applicant living in India:

1. a) Name:

__________________________________________________________

b) Complete postal address:

____________________________________________________

__________________________________________________________

c) Telephone number:

__________________________________________________________

2. a) Name:

__________________________________________________________

b) Complete postal address:

____________________________________________________

__________________________________________________________

c) Telephone number:

__________________________________________________________

18.

Details and mode of payment of fee:

_____________________________________________

DECLARATION

I HEREBY DECLARE THAT THE ABOVE STATEMENTS ARE TRUE TO THE BEST OF MY

KNOWLEDGE AND BELIEF.

Signature of the applicant

Two specimen signatures of the applicant:

1. Please enclose all relevant documents substantiating your claim as a Person of Indian Origin. (Please

also see Col. 13 and 14.

stamp size photographs .

2. Attach four recent

** 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.

Application Form For The Grant Renewal Of Pio Card Page 3