Serial No..

Department of Posts Government of India Application for Post Office Identity Card
(Please write in BLOCK LE E!S"

Please affi% re$ent stamp si&e $olo'r p#oto

1.

Name of t#e appli$ant

2.

Name of (at#er)*'s+and)G'ardian

3.

Date of Birt# (dd)mm),,,,"

-. Si.nat're of t#e /ppli$ant (Please si.n in t#e +o%"

5.

Present postal address wit# PIN

6.

Permanent postal address wit# PIN

7.

Date sin$e residin. at t#e address at serial 0 (dd)mm),,,,"

8.

If ,o' are a tenant1 please f'rnis# parti$'lars (name1 address)telep#one n'm+er)mo+ile n'm+er)email id" of t#e landlord

9.

Parti$'lars of Emplo,ment identit, (if emplo,ed". Please atta$# p#oto $op, of ID $ard iss'ed +, t#e emplo,er

10.

/ddress of t#e emplo,er wit# PIN2

11.

Personal parti$'lars

elep#one No. wit# area $ode

3o+ile n'm+er Blood Gro'p

Personal mar4s of identifi$ation

12.

*ave ,o' applied for PO ID earlier2

5es

No

a. b. 13.

Stat's of t#e appli$ation2 Card iss'ed ) $ard not iss'ed If Card iss'ed1 stat's of t#e Card 2

(ee Pres$ri+ed 2 !s.

Certified t#at t#e information f'rnis#ed a+ove is tr'e to +est of m, 4nowled.e. #e PO ID $ard iss'ed on t#e +asis of t#is appli$ation imposes no le.al lia+ilit, on India Post. If t#e address .iven is fo'nd 6false7 or 6 +o.'s7 or not verifia+le t#e pro$essin. fee s'+mitted ma, +e forfeited +, India Post. Pla$e2 Date2 (Si.nat're of t#e /ppli$ant" (FOR OFFICE USE ONLY)

!e$eipt No. Date

for !s.

Si.nat're of t#e P/ re$eivin. t#e /ppli$ation 8 (ees Details verified. PO ID $ard ma, +e iss'ed ) not +e iss'ed. Dated 2 (Name1 Si.nat're 8 Stamp of t#e 9erif,in. Offi$ial"

PO ID Card ma, +e iss'ed ) not +e iss'ed +ased on t#e Dated 2 (Name1 Si.nat're 8 Stamp of t#e Postmaster"

 . Serial No of t#e Card iss'ed Date of Iss'e

(Name1 Si.nat're 8 Stamp of Postmaster"