Additional Particulars Form (For Visa/oci/pio Card Services) Page 2
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211
Current Employment status along with full details of employer :
12
Has the applicant been convicted for any criminal offense or is
currently facing criminal charges in any court of law? If yes,
specify details
:
13
Has the applicant ever applied for asylum? If yes, specify details:
DECLARATION
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 a PIO card (strike off 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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