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ADDITIONAL PARTICULARS FORM FOR PIO CARD SERVICES Please note - All questions must be answered with details. Where applicable please answer as Yes or No. Do not answer as N/A. Incorrect / Incomplete applications and applications answered in N/A will not be processed. Name of Applicant Passport Number and Nationality Please specify whether holding dual nationality. ADDITIONAL PARTICULARS FORM FOR PIO CARD SERVICES Please note - All questions must be answered with details. Where applicable please answer as Yes or No* Do not answer as N/A. Incorrect / Incomplete applications and applications answered in N/A will not be processed* Name of Applicant Passport Number and Nationality Please specify whether holding dual nationality. If yes please provide name of countries and passport numbers Any previous Nationality held If yes specify Name of Spouse and current Nationality Any other Nationality previously held by spouse If yes please provide name of countries and passport numbers Has the applicant ever changed his/her name If yes specify details and submit appropriate documentation for the same Did the applicant or his/her parents or his/her grandparents ever hold the citizenship of Bangladesh Afghanistan Bhutan China Nepal or Sri Lanka at any point of time If yes please provide details Whether the applicant or his/her parents or his/her grandparents ever hold the citizenship of Pakistan or NICOP National Identity Card for Overseas Pakistanis or POC Pakistan Origin Card If yes specify details Armed Forces/Police/Para-Military Forces/Government service If yes name of Organization Designation Place of Posting and Rank should be given If yes specify details Current Employment status along with full details of employer or is currently facing criminal charges in any court of law 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 PIO card and any other action as deemed fit by the Government of India or its agencies. Date Place Signature of the Applicant Please note In case of minor child both parents/legal guardian should sign the declaration. Where applicable please answer as Yes or No* Do not answer as N/A. Incorrect / Incomplete applications and applications answered in N/A will not be processed* Name of Applicant Passport Number and Nationality Please specify whether holding dual nationality. If yes please provide name of countries and passport numbers Any previous Nationality held If yes specify Name of Spouse and current Nationality Any other Nationality previously held by spouse If yes please provide name of countries and passport numbers Has the applicant ever changed his/her name If yes specify details and submit appropriate documentation for the same Did the applicant or his/her parents or his/her grandparents ever hold the citizenship of Bangladesh Afghanistan Bhutan China Nepal or Sri Lanka at any point of time If yes please provide details Whether the applicant or his/her parents or his/her grandparents ever hold the citizenship of Pakistan or NICOP National Identity Card for Overseas Pakistanis or POC Pakistan Origin Card If yes specify details Armed Forces/Police/Para-Military Forces/Government service If yes name of Organization Designation Place of Posting and Rank should be given If yes specify details Current Employment status along with full details of employer or is currently facing criminal charges in any court of law If YES specify details.

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