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Name

State

Passport Size Photo

(jpg, png or gif images only. 160x200 pixels (width x height). Maximum size 1000 KB)

Birth Certificate

(Maximum size 1000 KB)

Type

Are you a PIO/OCI

Yes No

TELEPHONE / FAX

EMAIL ADDRESS

SON / DAUGHTER OF

Relationship

Gender

MOTHER TONGUE

MOBILE PHONE

Date of Birth

ADDRESS