Sample Application Form 28.11.12

7/29/2019 Sample Application Form 28.11.12

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Click here to reprint already registered

application form

Select the Indian High Commission that

you are applying in

Select the service that you are applying for

Under Surname, type your Family name.

Under Given name, type your first &

middle name

If you have ever changed your name click

the box and indicate previous name in full

Select your sex from the drop down. Fill in

the date of birth in DD/MM/YYYY format.

Type state or country of birth.

Type your present profession

Type your height in cms only

Type the color of your hair

Type your place of birthType your qualification; please mention

Nil if you are uneducated

Type any visible mark (i.e Moles, Scars etc)

Type the color of your eyes

Type your present US address, as the samewill be printed on the passport. Phone

number could be your local number, that

could be used to contact you. Please type

your active email id as the same will be

used to contact you.

Type your Indian Address here, please

note that State & Pin code is a must.

Mobile No. could be your local number

Please note:- Applicant's Family

Information(All Names should be in

full. Initials and titles such as Mr, Mrs,Dr etc. are not allowed.)


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Select the martial status from the

dropdown

If selected Married or Widow/Widower,

please fill-in the spouses Name andNationality; you would be required to

provide a notarized copy of themarriage certificate /divorce degree

/death certificate as per your selection

Fill-in your Parents names, place ofbirth and country and their nationality

at the time of your birth

If you have / had valid or expired

passport, please click on this boxand fill the details below

Fill-in the existing passport details.Please note: in case of lost passport,

kindly provide proposed information

Once the entire data is filled, hitsave and print.


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Upon saving a pop-up would ask toverify the details again. Press OK to

Save and cancel to Re-edit

Post saving a pop-up would show atentative appointment. Please ignore the

same and press OK


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Please select any month and date; asthis appointment booked from this link is

invalid and would not be considered

Post selecting the month and date, hitconfirm appointment to print the 4 page

application form.

Please note:- The date printing on yourapplication form is not your appointment date.

For information on scheduling anappointment click here, for information on

sending application by post click here


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Please paste your unsigned recent color

photograph of 2 by 2 in size. Pleaseensure that the photos strictly satisfyspecifications. Click here for photo

specifications.

Please provide a specimen signature asyou want on your passport, please note

that the signature is inside the box.

Please fill the mode of payment as Cash/Money order / Cashiers Check or whichever mode you choose for the payment

Please fill the amount you paid for the

application

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Please fill the amount paid for the self

addressed prepaid envelope.

Please note that the rest of the details onthis page will be picked from the onlineform you filled. Please DO NOT overwriteany pre-printed information on theapplication form If there is any correctionrequired on the pre-printed information of the

application form, discard the old application form

and refill a new application form.

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Mention the particulars of the person to be

intimated in event of death or accident

Mention the particulars of the present

Passport/ Nationality, Identity card if any

Mention the Local drivers License details if

available, if not please mention NIL

Your educational qualification will be picked

from the online form you filled

Please fill the date when you left India to stay

abroad.Please fill in the recent date of visit to India

Your total stay away from India

Select ECNR or ECR as mentioned on your

existing passport, If the same is not availableon our ass ort ou ma select ECNR.

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Please note: The Reference number printed

on the application form is not valid fortracking purpose, post submission of you

form at the center a new reference numberwill be issued and the same could be used

for tracking. Also, the date printing on theapplication form is NOT your appointmentdate. For information on scheduling an

appointment click here, for information onsending your application by post click here.

Please mention your profession and thephone number

(i.e Self-employed, Homemaker, Service,Retired etc.)

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Please select if you are citizen bybirth/Descent/Nationalization/Registration.

If you ever possessed any othernationality/passport/ travel document of anyother country. Please mention the details of

the same or else NA"

Select Yes or No as appropriate

Please provide the name and address of tworelatives/friends. This would be used for

verification

Please provide the details as instructed

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In case of Lost/ Damage passport pleaseprovide the details


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Please provide specimen signature / thumbimpression ( Left hand thumb impression if male

and Right hand thumb impression if female) incase of a lost or damaged passport and get this

page notarized.


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Please provide specimen signature / thumb

impression ( Left hand thumb impression if maleand Ri ht hand thumb im ression if female in

In case the application is for a minor, please

provide details as requested here. Signature /

thumb impression ( Left hand thumb impressionif male and Right hand thumb impression iffemale) of both the parents / guardian is required.

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both the boxes

Documents

Sample Application Form 28.11.12