Australia PIO Application, Form O, Indian High Commission

FORM O
Paste photo with a
light background
and No Border
2 inch
2 inch
APPLICATION FORM FOR THE GRANT/RENEWAL OF A PIO CARD
SOUTH AUSTRALIA & NSW: Recommended Option, apply by Registered POST, mail in your application to: GPO Box 2892
SYDNEY NSW 2001 or Queue in person at IPVSC, Encounter Australia 63 Grote Street, Adelaide, South Australia 5000. Or Queue
in person at IPVSC, Level 1, 64, Clarence Street, Sydney 2000.
VICTORIA & TASMANIA: Recommended Option, apply by POST, mail in your application to: PO Box 23057
DOCKLANDS VIC 3008 or Queue in person at IPVSC, Suite 4.Level 12, 55 Swanston Street, Melbourne, VIC 3000.
QUEENSLAND & ACT: Recommended Option, apply by POST, mail in your application to: PO Box 936, Civic Square, ACT
2608 or Queue in person at IPVSC,Level 3, 490 Upper Edward Street,Spring Hill,Brisbane, QLD - 4000. Or Queue in person at
IPVSC, Unit 2, 20 Allara, Canberra city, Canberra ACT 2601.
NORTHERN TERRITORY & WESTERN AUSTRALIA: Recommended Option, apply by POST, mail in your application to:
Locked Bag 200 PERTH BC WA 6849 Or Queue in person at IPVSC, Level 1, Room 22, 195 Adelaide Terrace (Good Earth
Hotel); Perth WA – 6004
.
POST: You must add $13.50 (inclusive of GST) Postal Processing Fee. This is to return your
processed/unprocessed (in case incomplete) application.
Download the checklist for your visa application from www.vfs-in-au.net
READ INSTRUCTIONS CAREFULLY. INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED
FEE PAID A $___________ POSTAL CHARGES A$_____________
DETAILS AND MODE OF PAYMENT OF FEE: CASH / BANK CHEQUES / AUSTRALIAN M.O
1. (a) Name of the applicant _______________________________________________________________
(Surname)
(Middle Name)
(Given Name)
(b) Surname at birth (if any) _______________________________________________________________
(c) Other names (where applicable) _________________________________________________________
(d) Date of birth __________________________
(Day/Month/Year)
(e) Place of birth ________________________________________________________________________
(City)
(State)
(Country)
(Pin Code)
2. (a) Father’s name __________________________________________ Nationality _________________
(Surname)
(Given Names)
(b) Mother’s name ___________________________________________ Nationality _________________
(Surname)
(Given Names)
(c) Spouse’s name (where applicable) _____________________________ Nationality ________________
(Surname) (Given Names)
3. (a) Present Address ____________________________________________________________________
City _________________ State ________________ Post Code ____________ Tel. No. ______________
(b) Permanent Address ___________________________________________________________________
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City _________________ State ________________ Post Code ____________ Tel. No. _______________
(c) Address in India (verifiable) ____________________________________________________________
City _________________ State _________________ Pin Code ____________ Tel. No. _____________
4. Profession or occupation ________________________________________________________________
5. Business/Office address ________________________________________________________________
City _________________ State _________________ Post Code ___________ Tel. No. _____________
6. Male/Female __________________ 7. Marital status: Married/Unmarried ________________________
8. Nationality (at the time of birth) __________________________________________________________
9. Present nationality (if different) _____________________ Date on which acquired _________________
(Day-Month-Year)
10. (a) Passport No._______________ (b) Date of issue ______________(c) Date of expiry ____________
(Day-Month-Year)
(Day-Month-Year)
(d) Country, which issued the Passport ____________________ (e) 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) Passport Number __________________ (b) Date of issue ________________________
(Day-Month-Year)
(b) Place of issue __________________________________(d) Date of expiry ____________________
(Enclose photocopy of relevant documents)
(Day-Month-Year)
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:
(a) Date of birth ___________________ (b) Place of Birth _______________________________________
(Day-Month-Year)
(c) 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 of application, purpose, reasons for refusal etc.)
____________________________________________________________________________________
16. Details of previous PIO Card (wherever applicable):
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(a) Date of issue _____________ (b) Date of expiry _____________ (c) Place of issue ________________
(Day-Month-Year)
(Day-Month-Year)
17. Name & complete addresses of two persons known to the applicant living in India:
(1) Name ______________________________________________________________________________
(Surname)
(Middle name)
(Given name)
City __________________ State ________________ Pin Code _____________ Tel. No. ______________
(2) Name ______________________________________________________________________________
(Surname)
(Middle name)
(Given name)
City __________________ State ________________ Pin Code _____________ Tel. No. ______________
DECLARATION
I hereby declare that the above statements are true to the best of my knowledge and belief.
_______________________________________________
Signature of the applicant or sign of both parents for
minors unable to sign/affix thumb impression.
If unable to sign - left hand thumb impression
If male & right hand thumb impression if female
SPECIMEN SIGNATURES OF APPLICANT
(PLEASE SIGN WITHIN THE BOX ONLY)
(APPLICATION WILL REMAIN UNPROCESSED WITHOUT APPLICANT’S SPECIMEN
SIGNATURES) Do not affix thumb impressions in the boxes below. For Minors unable to sign , both
parents must sign on the line above.
1. Please enclose all relevant documents substantiating your claim as a person of Indian origin.
(Please also see Col. 13 and 14).
2. Attach three recent passport size photographs.
3. For minor children (under 15 years) application MUST be furnished with following documents:
a. Copy of Date of Birth certificate,
b. No Objection Letter from both the parents along with the photocopy of the relevant pages of their
passports to verify signatures,
c. Both parents MUST sign the PIO application for minor children.
d. Affidavit for Minor applicant.
Note:
• Acceptance of application form does not confirm any right on the applicant to the PIO Card.
• Furnishing of false information will result in summary rejection of the application.
Application and Service Terms
“By Submitting this application, you will be taken to have read, understood and accepted the terms
contained in the document titled “Application and Service Terms” which can be viewed by:
1.
2.
Visiting the following website link: http://www.vfs-in-au.net
Contacting us by telephone on the number specified in the “contact us” section of the website
http://www.vfs-in-au.net
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3. Visiting your local India Passport and Visa Services Centre and requesting a copy of the terms
at the counter or viewing the terms displayed on the notice board at the centre.”