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EMBASSY OF INDIA, DOHA (QATAR)

APPLICATION FORM FOR THE GRANT / RENEWAL OF A PIO CARD

(To be filled up in Duplicate)


1.  (a) Name of the applicant

    (b) Surname at birth (if any)

    (c) Other names (where applicable)

    (d) Date of birth     Pick a date 
    (e)Place of birth (town, city, country)

2. Father’s / Mother’s / Spouse’s Name & Nationality :
    (a) Father

    (b) Mother

    (c) Spouse (where applicable)


3. Address :
    (a) Present :
 
 


    (b) Permanent :
 
 


    (c) Address in India (verifiable)
 
 

4. Profession or occupation

5. Business / Office Address
 
 

6. Sex Male / Female

7. Marital Status   Married / Unmarried

8. Nationality (at the time of birth)

9.(a) Present Nationality (if different)
   (b) Date on which acquired   Pick a date 
10.Passport particulars of applicant
    (a) Passport Number
    (b) Date of Issue   Pick a date 
    (c) Date of Expiry   Pick a date 
    (d) Country which issued the Passport   
    (e) Place of Issue   
11. Does the applicant hold dual nationality? YES / NO
(If so, please give details including the details of all the passports held, etc.)
 
 
 

12. Did the applicant at any time hold the nationality of any country other than the present nationality?         YES / NO
 If so, please give details including the period
 
 
 

13.Whether the applicant or either of his / her parents or grand-parents or great grand-parents held an Indian passport at any time.         YES / NO
 If so, details thereof.
 (a) Passport Number
 (b) Date of Issue    
 (c) Place of Issue
 (d) Date of Expiry    
    (Enclose photocopy of relevant documents)

14. Whether the applicant or either of his / her parents or any of his / her grand-parents or any of his / her grand-parents was born and was permanently resident in India as defined in the Government of India Act, 1935* at any time.         YES / NO
 If so, following details may be indicated :  
 (a) Date & Place of Birth
 (b) Proof of residence, etc.
    (Enclose photocopy of relevant documents)
 (Note : If applicant is the spouse of a citizen of India or a person of Indian origin, his / her particulars should be indicated)
 

15. Has the applicant ever been refused Indian passport / travel document or visa for visiting India?          YES / NO
  If so, give complete details  
 (a) Place
 (b) Date of application    
 (c) Purpose
 (d) Reasons for refusal

16. Details of previous PIO Card (wherever applicable) :
    (a) Date of Issue   Pick a date 
    (b) Date of Expiry   Pick a date 
    (c) Place of Issue   
17. Name and complete addresses of 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 :

(TO BE FILLED IN DUPLICATE BY ALL APPLICANTS)

ADDITIONAL INFORMATION TO BE FURNISHED BY ALL THE APPLICANTS

1) Mode of acquiring the present Nationality by the Applicant :
a) By Birth  b) By naturalization  c) Any other  

2) Any other Nationality of Applicant's Father :
 ( other than the one mentioned in Part-A )

3) Name & Nationality of Applicant's Mother :
Name :  
Nationality :  

4) Any other Nationality of Applicant's Mother :
 ( present or previous )

5) Name & Nationality of Applicant's paternal Grandfather :
Name :  
Nationality :  

6) Name & Nationality of Applicant's paternal Grandmother :
Name :  
Nationality :  

7) Name & Nationality of Applicant's maternal Grandfather :
Name :  
Nationality :  

8) Name & Nationality of Applicant's maternal Grandmother :
Name :  
Nationality :  


9) Nationality of Applicant's Spouse :

10) Countries visited by the Applicant during the last 10 years :

11) The address of friends / relatives / places of stay during the previous travel to India :
  
  

12) Places from where visa was acquired during previous visits :

13) Telephone and Mobile number in India of :
Applicant :  
His / Her sponsor :  


Date : Pick a date