Form O - Pio Card Application/renewal Page 3
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3(a) Date of issue _____________ (b) Date of expiry _____________ (c) Place of issue ________________
(Day-Month-Year)
(Day-Month-Year)
17. Name & complete addresses of two persons known to the applicant living in India:
(1) Name ______________________________________________________________________________
(Surname)
(Middle name)
(Given name)
City __________________ State ________________ Pin Code _____________ Tel. No. ______________
(2) Name ______________________________________________________________________________
(Surname)
(Middle name)
(Given name)
City __________________ State ________________ Pin Code _____________ Tel. No. ______________
DECLARATION
I hereby declare that the above statements are true to the best of my knowledge and belief.
_______________________________________________
Signature of the applicant or sign of both parents for
minors unable to sign/affix thumb impression.
If unable to sign - left hand thumb impression
If male & right hand thumb impression if female
SPECIMEN SIGNATURES OF APPLICANT
(PLEASE SIGN WITHIN THE BOX ONLY)
(APPLICATION WILL REMAIN UNPROCESSED WITHOUT APPLICANT’S SPECIMEN
SIGNATURES) Do not affix thumb impressions in the boxes below. For Minors unable to sign , both
parents must sign on the line above.
1. Please enclose all relevant documents substantiating your claim as a person of Indian origin.
(Please also see Col. 13 and 14).
2. Attach three recent passport size photographs.
3. For minor children (under 15 years) application MUST be furnished with following documents:
a. Copy of Date of Birth certificate,
b. No Objection Letter from both the parents along with the photocopy of the relevant pages of their
passports to verify signatures,
c. Both parents MUST sign the PIO application for minor children.
d. Affidavit for Minor applicant.
Note:
• Acceptance of application form does not confirm any right on the applicant to the PIO Card.
• Furnishing of false information will result in summary rejection of the application.
Application and Service Terms
“By Submitting this application, you will be taken to have read, understood and accepted the terms
contained in the document titled “Application and Service Terms” which can be viewed by:
1. Visiting the following website link:
2. Contacting us by telephone on the number specified in the “contact us” section of the website
F/AUS/IND/05
3/3
PIO Card Form
3. Visiting your local India Passport and Visa Services Centre and requesting a copy of the terms
at the counter or viewing the terms displayed on the notice board at the centre.”
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