ADDITIONAL PARTICULARS FORM FOR RENUNCIATION SERVICES
1.Nameof Applicant:
2.
Passport
NumberandNationality :
3.Pleasespecifywhetherholdingdualnationality. :
Ifyes,please
providenameofcountriesand
passport
numbers
4.AnypreviousNationalityheld?Ifyes,specify :
5.
NameofSpouseandcurrentNationality :
6.AnyotherNationalitypreviouslyheldbyspouseIfyes, :
pleaseprovidenameofcountriesand
passport
numbers
7.
Hastheapplicanteverchangedhis/hername?Ifyes, :
specifydetails
and
submit
appropriatedocumentationfor
thesame
8.
Didtheapplicantorhis/herparentsorhis/hergrandparents
:
ever
holdthecitizenshipofBangladesh,Afghanistan,Bhutan,
China,NepalorSriLankaatany
point
oftime?
Ifyes,please
providedetails
9.Whethertheapplicantorhis/herparentsorhis/her :
grandparentseverholdthecitizenshipofPakistan,or
NICOP(NationalIdentityCardforOverseasPakistanis)or
POC(PakistanOriginCard)?Ifyes,specifydetails
10.
DidtheapplicantworkbeforeoriscurrentlyWorkingwith :
ArmedForces/Police/Para-MilitaryForces/Government
service.Ifyes,nameofOrganization,Designation,Place
ofPostingandRankshouldbegiven
11.Didtheapplicanteverholdofficial/diplomaticpassport? :
Ifyes,specifydetails
12. CurrentEmploymentstatusalongwithfulldetailsofemployer :
13. Has the applicant ever been convicted of any criminal offense :
or is currently facing criminal charges in any court of law?
If YES, specify details.
14. Has the applicant or any of his parents ever applied for asylum?:
If yes, specify details
DECLARATION
Iherebydeclarethattheaboveparticularsaretrue. Ialsoagreethatincaseanyfalseinformationisgivenin
theaboveform,appropriateactionasperGovernmentofIndiarulesandregulationsmaybetakenagainstme,includingbut
notlimitedtorevokingofissued RenunciationandanyotheractionasdeemedfitbytheGovernmentofIndiaorits
agencies.
Iamapplyingfora OCIcard(strikeoffwhichevernotapplicable)-
(a)
(b)
as a spouse ofanIndianoriginperson
not
asaspouseofIndianoriginperson.
Incaseof(a),IundertaketointimatetheConsulateimmediatelyaboutthedissolutionofsuchmarriage,ifitoccurs.
( ) I hereby certify that I, the applicant for whom the visa is requested, am physically present in the consular jurisdiction of the
Consul General of India, San Francisco, at the time of applying for visa.
Date:
Place:___________________________
(SignatureoftheApplicant)
Pleasenote:Incaseofminorchild,bothparents/legalguardianshouldsignthedeclaration
click to sign
signature
click to edit
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