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A (for each applicant of the family) Affix your photo of 35X35 mm Size Signature Box First Applicant Details: 1 Surname 2 Given Name* 3 Sex and Date of Birth* 4 6 Place of Birth with country* Father/Guardian s Name* Mother s Name* 7 Nationality* 8 Passport No. and Date of Issue* Place of Issue* (DD/MM/YYYY) 5 9 10 Occupation* 11 Visible Distinguishing Mark* 12 Present Address* 13 E-Mail ID and Phone No 14 Whether PIO Card Yes/No holder? PIO Card No & Date of Issue Valid Upt.

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