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CONSULATE GENERAL OF INDIA540, ARGUELLO BOULEVARD,

SAN FRANCISCO, CA-94118

PHONE NO. (415) 668-0662 / 668-0683

FAX No. (415) 668-9764

http://www.cgisf.org

Info@cgisf.org

APPLICATION FORM FOR THE GRANT / RENEWAL OF A PIO CARD

(TO BE FILLED UP IN DUPLICATE)

1. (a) Last Name :________________________________________

(b) First Name :_______________________________________

(c) Surname at birth (if any) : ___________________________

(d) Other names (where applicable) :_____________________

(e) Date of birth (dd/mm/yy) :___________________________

(f) Place of birth : (Town, City & Country) :____________________________

2. Fathers/Mothers/Spouses name & nationality :

Father Mother Spouse (where

applicable)

Name

Nationality

3. Address :

(a) Present :_______________________________________________________

(b) Phone No.:_____________________________________________________

(c) Permanent Address in India (verifiable) :___________________________

4. Profession or occupation :___________________________________________

PASTE 2" x 2"

PHOTO HERE

FRONTAL VIEW

(COLOR or B&W)

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5. Business/office address :_____________________________________________

6. 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 (dd/mm/yy)________________________________

10. Passport particulars of applicant :

Passport No. Date of issue Expiry date Country which

issued Passport

Place of issue

11. Does the applicant hold dual nationality? (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 ? 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 ? if so, details thereof :

a. Name & relationship with the applicant: ________________________________

b. Passport Number : (c) Date of issue :____________________________________

d. Place of issue : (e) Date of expiry(dd/mm/yy) :_____________________________

(Enclose photocopy of relevant documents)

14. Whether the applicant or either of his/her parents or any of his/her grand

parents or great grand parents was born and was permanently resident in

India as defined in the Government of India Act, 1935 * at any time ? if so,

following details may be indicated :

i. Name & relationship with the applicant : __________________________ii. Date & place of birth(dd/mm/yy) : _________________________________

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iii. 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 ? if so, give complete details (i.e. Place & date ofapplication, purpose, reasons for refusal etc.)

16. Details of previous PIO Card (wherever applicable) :

Date of issue Date of expiry Place of issue

17. Name & complete address of two persons known to the applicant living in India :

Name/relationship Complete postal address Telephone No.

18. Details & mode of payment of fee :

DECLARATIONI hereby declare that the above statements are true to the best of my knowledge and belief.

________________________

Signature of the applicant

Two specimen signatures with of the applicant (within the box)

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Instructions

Q: What documents are required to be submitted for issue of a PIO Card?

A: Required documents are listed below:-

1. Completed application form in duplicate (for very young children, thumb impression in place ofsignatures)

2. Photographs- 4 (four) latest, preferably in color, front facing, 2" x 2"

3. Indian Passport in original (the last one acquired by applicant), with copy of first 3 and last 3 pagesonly.

4. Copy of U.S. Passport (notarized copy) [Page with particulars only]

5. Proof of permanent address in India as per Indian Passport. If there has been a change of address,documentary evidence to support it, duly notarized.6. In respect of children born in USA:

a. Notarized copy of Parents Indian Passports [First 3 and Last 3 pages Only]b. Notarized copy of the Child US Passport [First 3 and Last 3 pages Only]c. Photocopy of birth certificate in case of applicants under 18 years

7. Fees of $ 370 ( for adults) or $ 185 (for children up to the age of 18 years) Mail back charges(preferably $20 for return by overnight mail which is more reliable and safe. Consulate can not takeresponsibility for delay in receipt or loss of documents sent by certified mail. No self addressed envelopenecessary. Fees for PIO Card + mailing charges can be sent together through a single money orderor cashiers check. Please note that payments by mail can only be made through money order orcashier's check in favour of the Consulate General of India.