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VANCOUVER
OCI Registration Form
FORM XIX (See Rule 25B)
Application for registration as an Overseas Citizen of India under
section 7A of the Citizenship Act,1955
Affix your photo
of size 50X50mm
Approx
CANVI0976513
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Signature >
Personal Particulars (As in Passport)
1. Surname YAJJALA
2. Given Name JOHN
3. Previous Name
4. Sex MALE 5. Date of Birth 02-FEB-1973
6. Marital Status MARRIED
7. Place of Birth ALAJANGI
8. Nationality
CANADA
9. Visible Distinguishing Mark
LEFT HAND WRIST
Family Details
10. Father Name YAJJALA SAMUEL
11. Father Nationality INDIA
12. Mother Name YAJJALA SAROJINI
13. Mother Nationality INDIA
14. Spouse Name ARAN JYOTHI KOTA
15. Spouse Nationality CANADA
Passport Details
16. Passport No QH564537 17. Date Of Issue 12-MAY-2012
18. Place of Issue SURREY
Occupation Details
19. Occupation PROFESSIONAL
20. Employer Address CITY OF BURNABY
Applicant's Contact Details
21. Present Address 9310 CINNAMON DR, SURREY
BC V3V1V2
22. Email yajjala@gmail.com
23. Phone No 7782315906
PIO Card Details NO
24. Pio No NA 25. Date Of Issue NA
26. Place of Issue NA 27. Date Of Expiry NA
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VANCOUVER
OCI Registration Form
FORM XIX (See Rule 25B)
Application for registration as an Overseas Citizen of India under
section 7A of the Citizenship Act,1955
Affix your photo
of size 50X50mm
Approx
CANVI0976713
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Signature >
Personal Particulars (As in Passport)
1. Surname KOTA
2. Given Name ARAN JYOTHI
3. Previous Name
4. Sex FEMALE 5. Date of Birth 02-AUG-1974
6. Marital Status MARRIED
7. Place of Birth ANTIPETA
8. Nationality
CANADA
9. Visible Distinguishing Mark
LEFT HAND DORSAM
Family Details
10. Father Name KOTA LATCHAYYA
11. Father Nationality INDIA
12. Mother Name KOTA APPALANARASAMMA
13. Mother Nationality INDIA
14. Spouse Name JOHN YAJJALA
15. Spouse Nationality CANADA
Passport Details
16. Passport No WG048195 17. Date Of Issue 29-MAR-2013
18. Place of Issue SURREY
Occupation Details
19. Occupation DOCTOR
20. Employer Address MCC
Applicant's Contact Details
21. Present Address 9310 CINNAMON DR, SURREY
BC V3V1V2
22. Email yajjala@gmail.com
23. Phone No 7782315906
PIO Card Details NO
24. Pio No NA 25. Date Of Issue NA
26. Place of Issue NA 27. Date Of Expiry NA
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VANCOUVER
OCI Registration Form
FORM XIX (See Rule 25B)
Application for registration as an Overseas Citizen of India under
section 7A of the Citizenship Act,1955
Affix your photo
of size 50X50mm
Approx
CANVI0978513
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Signature >
Personal Particulars (As in Passport)
1. Surname YAJJALA
2. Given Name BHARATH SAMUEL
3. Previous Name
4. Sex MALE 5. Date of Birth 17-MAR-2004
6. Marital Status UNMARRIED
7. Place of Birth BOBBILI
8. Nationality
CANADA
9. Visible Distinguishing Mark
LEFT CHICK
Family Details
10. Father Name YAJJALA JOHN
11. Father Nationality CANADA
12. Mother Name KOTA ARAN JYOTHI
13. Mother Nationality CANADA
14. Spouse Name NA
15. Spouse Nationality NA
Passport Details
16. Passport No WG048189 17. Date Of Issue 27-MAR-2010
18. Place of Issue SURREY
Occupation Details
19. Occupation NA
20. Employer Address NA
Applicant's Contact Details
21. Present Address 9310 CINNAMON DR, SURREY
BC V3V1V2
22. Email yajjala@gmail.com
23. Phone No 7782315906
PIO Card Details NO
24. Pio No NA 25. Date Of Issue NA
26. Place of Issue NA 27. Date Of Expiry NA
Page 3 of 7
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VANCOUVER
OCI Registration Form
FORM XIX (See Rule 25B)
Application for registration as an Overseas Citizen of India under
section 7A of the Citizenship Act,1955
Affix your photo
of size 50X50mm
Approx
CANVI0978613
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Signature >
Personal Particulars (As in Passport)
1. Surname YAJJALA
2. Given Name SARAH JASMINE
3. Previous Name
4. Sex FEMALE 5. Date of Birth 01-JAN-2007
6. Marital Status UNMARRIED
7. Place of Birth SURREY
8. Nationality
CANADA
9. Visible Distinguishing Mark
RIGHT ARM BACK
Family Details
10. Father Name YAJJALA JOHN
11. Father Nationality CANADA
12. Mother Name KOTA ARAN JYOTHI
13. Mother Nationality CANADA
14. Spouse Name NA
15. Spouse Nationality NA
Passport Details
16. Passport No WG060195 17. Date Of Issue 03-MAY-2010
18. Place of Issue SURREY
Occupation Details
19. Occupation NA
20. Employer Address NA
Applicant's Contact Details
21. Present Address 9310 CINNAMON DR, SURREY
BC V3V1V2
22. Email yajjala@gmail.com
23. Phone No 7782315906
PIO Card Details NO
24. Pio No NA 25. Date Of Issue NA
26. Place of Issue NA 27. Date Of Expiry NA
Page 4 of 7
Part B (Other Details Of Applicant(s))
28. Have you/any member of your family applied for OCI Registration earlier?
No
29. Whether the applicant(s) sought asylum before applying for present citizenship?
No
30. Is (are) the applicant(s) or had ever been citizen of Pakistan or Bangladesh at any time?
No
31. Date and method of acquisition of present nationality
Applicant Name Acquisition Method Acquisition Date Previous Nationality
JOHN YAJJALA NATURALIZATION 18-MAY-2012 INDIA
ARAN JYOTHI KOTA NATURALIZATION 14-SEP-2009 INDIA
BHARATH SAMUEL
YAJJALA
NATURALIZATION 14-SEP-2009 INDIA
SARAH JASMINE
YAJJALA
BY BIRTH 01-JAN-2007 CANADA
32. Details of Family Members who are staying in India,if any
Sr No Name Present Address Relationship/Age
1 YAJJALA MOSES SWAMYVARI STREET BOBBILI VIZIANAGRAM AP INDIA BROTHER/35
2 YAJJALA ELIGIBETH RANI MARRIPALEM VIZAG AP INDIA SISTER/50
33. Details of Criminal Proceedings against the applicant(s),if any, anywhere.
Applicant(s) Name Date Of Incidence Place Of Incidence Nature Of Incidence Outcome
JOHN YAJJALA
NA NA NA NA
ARAN JYOTHI
KOTA
NA NA NA NA
BHARATH
SAMUEL YAJJALA
NA NA NA NA
SARAH JASMINE
YAJJALA
NA NA NA NA
34. I/We ............................. do solemnly and sincerely declare that the foregoing particulars stated on this
application are true ,and I/We make ths solemn declaration conscientiously believing the same to be true.
Date ........................
Place ........................ Signature ........................
Signature ........................
** Application for Minor(s)
I am a parent/guardian of .......................................................... to whom the foregoing particulars
relate. I hereby apply on behalf of my/the child (children) for his/her/their registration as an
Overseas Citizen(s) of India.
Date ............................................ Signature of Father/Guardian ............................................
Signature of Mother/Guardian ............................................
** To be filled only for minor applicant(s)
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Page 5 of 7
1.
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8.
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B.
I.
II.
III.

C.
D.
Instructions For Filling Application Form

Please write/print fields in BLOCK LETTERS.

A person who has not attained the age of 18 years is considered as minor. In case of minor who
cannot sign, his/her le thumb impression may be placed in the Signature Box. Parents should
not sign on behalf of minors.

Signature/Thumb impression should be confined in the prescribed box. In case of minor
applicants, parent should NOT sign in the box.

Photograph to be affixed on the application should be of square shape of size not less than
51*51mm (with 80% coverage by face). It should have plain light colour background without
border with front view of person's head and shoulders showing the full face in the middle of the
photograph. It should not be stapled and should not have any signature. Photographs that do
not conform to these standards will be rejected and may cause a delay in processing the
applications. Please see standards of acceptable photographs as Photo Link.

If there are any objections while processing the applications, the same will be displayed on the
Online Status Enquiry. Please follow the instructions and send requisite documents to the
Indian Mission/ Office where you have applied quoting the File (or Acknowledgement) Number.

Part A has to be filled for each applicant of the family and Part B is common for all applicants of the
family.

After successful registration , copy of Part A and Part B with an online registration number will be
printed. Application form on Parts A and B, complete in all respects, along with all relevant enclosures
must be submitted to the appropriate office.

Enclosures for each applicant:
Proof of present citizenship of applicant e.g. copy of Passport / citizenship certificate. In case of
applications filed in India, a copy of valid Visa / Residential Permit should also be enclosed.
Evidence of self or parents or grandparents,
being eligible to become a citizen of India at the time of commencement of the Constitution
i.e. on 26th January, 1950; or
belonging to a territory that became part of India after 15th August, 1947; or
being citizen of India on or after 26th January, 1950. These could be:
Copy of the passport; or
Copy of the domicile certificate issued by the Competent Authority ; or
Any other proof.
Evidence of relationship as parent/grandparent, if their Indian origin is claimed as basis for grant
of Overseas Citizenship of India.
Application fee by way of demand draft (US$ 275 for each applicant or equivalent in local
currency; US$ 25 for each PIO Card holder or equivalent in local currency). In case of applications
filed in India, a Demand Draft for Rs. 15,000 for each applicant drawn in favor of "Pay and
Accounts Officer (Secretariat), Ministry of Home Affairs" payable at "New Delhi" has to be
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Page 6 of 7
9.
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II.
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enclosed. The fee for PIO Card holders is Rs. 1,400 for Adults and Rs. 8,000 for Minors. For the
applications to be submitted outside India, please visit website of Indian Mission/ Post in the
respective country to get equivalent amount of fee to be paid along with application.
PIO Card holder should submit a copy of his/her PIO card.

The documents enclosed with the application should be self attested.

This form when completed should be submitted in duplicate (both sets must have original
photographs and signatures along with enclosures)-
In India to the Foreigners Regional Registration Officer (FRRO), Mumbai, Kolkata, Delhi,
Amritsar, Chennai, Hyderabad, Bangalore, Luck now, Kochi, Kozhikode, Thiruvananthapuram
(Trivandrum) and Goa.
Outside India, to the Indian Mission/ Post having jurisdiction over the country of which the
applicant(s) is a citizen or if he/she is not living in the country of his/her citizenship, to the Indian
Mission/ Post having jurisdiction over the country of which the applicant is ordinarily resident.
After receipt of application in concerned office, a File (or Acknowledgement) Number would be issued to
the applicant by way of acknowledgement. This would be communicated by email/post in case of
applications received by post


The applicant(s) can verify the status of their application(s) online by quoting the online
Registration Number or File(or Acknowledgement) Number.
Please contact Mission/Office where you have applied for OCI registration after 10 days from the date
of dispatch of documents from Delhi or any day after receipt of documents at the Mission/Office
whichever is earlier. Please produce your passports(s) and PIO card, if applicable, in person/through
authorized person for affixing OCI visa sticker and issuance of registration certificate. In case of
applications filed in India with FRRO, applicants should go to the FRRO office in person/through
authorized person.

Please check that all fields in the form are filled in and all necessary enclosures are attached
before submission of the form to Indian Mission/Post abroad or FRRO in India.

Concealment of any material fact or false representation etc. will lead to cancellation of
registration as Overseas Citizen of India. (Please refer to Section 7D of the Citizenship Act,
1955).
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