Application form for PIO miscellaneous services - High Commission ...
Application form for PIO miscellaneous services - High Commission ...
Application form for PIO miscellaneous services - High Commission ...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
<strong>High</strong> <strong>Commission</strong> of India<br />
London<br />
(To be filled in duplicate)<br />
Tel: 020 76323153, Fax: 020 76323073,<br />
Website: http:\\www.hcilondon.in<br />
<strong>Application</strong> <strong><strong>for</strong>m</strong> <strong>for</strong> <strong>PIO</strong> <strong>miscellaneous</strong> <strong>services</strong><br />
Note: Please fill the <strong><strong>for</strong>m</strong> in CAPITAL LETTERS using BLACK INK. All dates<br />
should be entered in DD/MM/YYYY <strong><strong>for</strong>m</strong>at. Please ensure that all sections are<br />
complete.<br />
Surname………………………………………Name…………………………………<br />
Maiden name……………………………………….Alias (if any)……………………<br />
Date of Birth…………………Place of Birth (town & country)………………………<br />
Nationality………………………………………………………………………………<br />
Passport No………………Date of issue…………… Date of expiry…………………..<br />
Passport issued by (authority/agency)………………………………………………….<br />
At (Place)………………………………………………………………………………<br />
Details of any other passport/nationality held (by you), now or earlier………………<br />
Sex: Male/Female…………….Occupation……………………………………………<br />
Business address………………………………………………………………………...<br />
…………………………………………………Postcode……………………………...<br />
Permanent address……………………………………………………………………..<br />
…………………………………………………Postcode……………………………..<br />
.<br />
Present address…………………………………………………………………………<br />
…………………………………………………Postcode……………………………..<br />
Telephone number with code: ……………………..Mobile:…………………………..<br />
E-mail address …………………………………………………………………………<br />
<strong>PIO</strong> Card No………………………………Date of issue……………….. …………….
Issued at………………………………..<br />
Date of expiry…………………………….<br />
Service required…………………………………………………………………………<br />
…………………………………………………………………………………………..<br />
Name, address and telephone number of two referees in UK and in India who could<br />
be contacted in case of need<br />
UK: (i)…………………………………… India (i)………………………………...<br />
………………………………………………………………………………..<br />
……………………………………………………………………………….<br />
UK:<br />
(ii)………………………………….. India (ii)………………………………...<br />
………………………………………………………………………………..<br />
. ……………………………………………………………………………….<br />
Declaration<br />
I, ……………………………………… hereby undertake that the in<strong><strong>for</strong>m</strong>ation<br />
given here is true, accurate and complete.<br />
Date:………………………………….<br />
Signature of applicant………………………
Change language