1078419149_content - CONSULATE GENERAL OF INDIA 3 EAST 64TH...

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CONSULATE GENERAL OF INDIA 3 EAST 64TH STREET (Bet. Madison and Fifth Avenue) NEW YORK, NY 10065 TEL (212) 774-0600. Fax (212) 570-9581 E-mail: passport@indiacgny.org For more information visit our website: www.indiacgny.org PASTE ONE PASSPORT SIZE PHOTOGRAPH HERE APPLICATION FOR MISCELLANEOUS SERVICES PLEASE SPECIFY THE SERVICE APPLIED FOR: _____________________________________________________________ PLEASE READ INSTRUCTIONS CAREFULLY BEFORE FILLING IN THIS FORM . Instructions can be obtained from the Consulate General of India, New York or from our web site. Incomplete application will not be accepted. This form may be duplicated if required. Effective 1 February 2004 . Applications are accepted from 9.15 A.M. to 12:15 P.M. on working days and passports delivered irrespective of date of application only between 4:30 to 5:15 P.M. Send exact amount of FEE either in the form of money order/certified check payable to Consulate General Of India or in CASH in bills no larger than $50/-. WE DO NOT ACCEPT PERSONAL CHECKS . Use only one form of payment. DO NOT SEND CASH IF APPLYING by mail. Also enclose payments (US$ 10 for priority mail or US$ 20 for Express mail) for return of ser viced documents by mail. We use only USPS express or certified mail for return of documents. 1. FULL NAME (Expanded Initials)____________________________________________________________________________________________ (Surname) (Given Names) 2. Applicant’s Driver’s License No. ___________________________________ Date and Place of issue _____________________________________ 3. Permanent Address in India ___________________________________________________________________________Tel:_________________ 4. Permanent Address in USA ___________________________________________________________________________ Tel:_________________ 5. Profession & Business Address_________________________________________________________________________Tel:_________________ 6. PLACE OF BIRTH _______________________________________ DATE OF BIRTH ________________________________________________ (Village/City & District) (DD/MM/YY) 7. CURRENT PASSPORT NO. ____________________________ PLACE OF ISSUE ___________________________________________________ DATE OF ISSUE _____________________________________ DATE OF EXPIRY ___________________________________________________ (DD/MM/YY) (DD/MM/YY) 8. NAME OF FATHER ____________________________________________________________________________________________________ 9. NAME OF MOTHER ____________________________________________________________________________________________________ 10.NAME AND NATIONALITY OF SPOUSE __________________________________________________________________________________ 11.IS APPLICANT REGISTERED WITH THE CONSULATE GENERAL? IF NOT IS A MEMBER OF ANY INDIAN ORGANISATION? GIVE DETAILS ____________________________________________________________________________________________________________________ TYPE OF SERVICE(S) REQUIRED
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This note was uploaded on 04/05/2011 for the course EE 5368 taught by Professor Staff during the Spring '08 term at UT Arlington.

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1078419149_content - CONSULATE GENERAL OF INDIA 3 EAST 64TH...

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