Consulate General Of India
HOUSTON Affix your photo
4300 SCOTLAND ST HOUSTON of size 50X50mm
TEXAS 77007 Approx
www.cgihouston.org
7136262148
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
Application Date : 26-FEB-2019 ( 2019/ OCI/ 0004887)
Personal Particulars (As in Passport)
1. Surname BOLLEDDU
2. Given Name SAMUEL ABISHAI
USAH01317X19
3. Sex MALE 4. Date of Birth 28-MAY-2009
5. Country(Birth) UNITED STATES 6. State (Birth) NA
7. Place of Birth NEW JERSEY
8. Marital Status UNMARRIED
9. Nationality UNITED STATES
10. Visible Distinguishing Mark NONE
Family Details
11. Father Name PRABHAKAR RAO BOLLEDDU
File Ref No : USAH01317X19
12. Father Nationality INDIA
13. Mother Name MARY JYOSTNA RANI LINGAMGUNTA
14. Mother Nationality INDIA
Passport Details
15. Passport No 595485318 16. Date Of Issue 23-JAN-2019
17. Place of Issue USA
Occupation Details
(In Lieu Of Valid PIO-Card)
18. Occupation NA
19. Employer Address NA
Applicant's Contact Details
20. Present Address 540 EVENING SUN DRIVE,, PROSPER, TX 75078
21. Email marylingamgunta@gmail.com 22. Phone No 2625102498
Document Details
23. Uploaded Document 1) CURRENT INDIAN PASSPORT OF PARENTS/GRAND PARENTS/GREAT GRAND PARENTS/SPOUSE
2) CURRENT PASSPORT 3) RELATIONSHIP CERTIFICATE 4) PIO CARD
PIO Card Details YES
24. Pio No P0436578 25. Date Of Issue 29-SEP-2009
26. Place of Issue NEW YORK 27. Date Of Expiry Lifelong
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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. Whether the applicant(s) had ever been citizen of Pakistan or Bangladesh at any time? No
31. Whether either of parents or grandparents or great-grandparents of applicant(s) had ever No
been citizen of Pakistan or Bangladesh at any time?
32. Whether the applicant(s) (other than minor child/children) has worked / is working in No
Armed Forces/Para-military/Police/security/intelligence organizations?
33. Date and method of acquisition of present nationality
Applicant Name Acquisition Method Acquisition Date Previous Nationality
SAMUEL ABISHAI BY BIRTH 28-MAY-2009 NA
BOLLEDDU
34. Details of Family Members who are staying in India,if any
Sr No Name Present Address Relationship/Age
1 LEELA MYRALA D-NO-51-1-102, KABADIPALEM, ONGOLE, ANDHRA GRAND MOTHER/68
PRADESH
35. Details of Criminal Proceedings against the applicant(s),if any, anywhere.
Applicant(s) Name Date Of Incidence Place Of Incidence Nature Of Incidence Outcome
SAMUEL ABISHAI NA NA NA NA
BOLLEDDU
File Ref No : USAH01317X19
36. 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 ............................................
** 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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Instructions For Filling Application Form
1. Please write/print fields in BLOCK LETTERS.
2. A person who has not attained the age of 18 years is considered as minor. In case of minor who cannot
sign, his/her left thumb impression may be placed in the signature box. Parents should not sign in
behalf of the children.
3. Signature/Thumb impression should be confined in the prescribed box. In case of minor applicants,
parent should NOT sign in the box.
4. Photograph to be affixed on the application should be a square shape of size not less than 51*51mm
(with 80% coverage of face). It should have plain light color background (not white) without the border
with front view of person's head and shoulders showing the full face in middle of the photograph. It
should not be stapled and 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.
5. 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.
6. After successful registration , copy of Part A and Part B with an online registration number will be
File Ref No : USAH01317X19
printed. Application form on Parts A and B, complete in all respects, along with all relevant enclosures
may be submitted to the appropriate office.
7. Enclosures to be attached with the application:
I. In case of applications for registration as Overseas Citizen of India Cardholder in lieu of PIO
card, only copies of the following documents to be attached:-
1. Valid passport of the applicant
2. Valid PIO card of the applicant.
II. In case of fresh applications for registration as OCI Cardholder, following documents to be
attached:-
(A) Proof of present citizenship – Copy of present valid passport (applicable in all cases), with
validity of minimum 6 months at the time of submission of application.
(B) In case application is submitted in India, copy of any type of Visa (other than Missionary Visa
and Mountaineering Visa)/ Residential Permit with 3 months validity as on the date of
application.
(C) Evidence of self or parents or grandparents or great grandparents being a citizen of India at the
time of, or at any time after the commencement of the Constitution i.e. 26.01.1950 or being
eligible to become a citizen of India at the time of commencement of the Constitution i.e.
26.01.1950 or belonging to a territory that became part of India after 15th August, 1947:-
These could be:
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(a) Copy of the Indian Passport; or
(b) Copy of the Domicile Certificate issued by the Competent Authority; or
(c) Copy of Nativity Certificate from the Competent Authority; or
(d) OCI Card/ PIO card of parents/ spouse along with the base papers/ documents upon
which the OCI/ PIO card was issued; or
(e) Any other proof substantiating the request. Usually applicants are able to submit a
certificate of residence or place of birth of self/parents/grandparents from First Class
Magistrate/District Magistrate (DM) of the concerned place.
(D) Evidence of relationship as parent/grandparent/ great grandparent, if their Indian origin is
claimed as basis for registration as OCI Cardholder:The document of relationship could be
“Birth Certificate” issued from competent authority mentioning both parents’ name. In case the
birth certificate is issued by a foreign authority, it is to be Apostled or endorsed by the
concerned Indian Mission abroad
(E) In case of minor child whose both parents are citizens of India or one of the parents is a citizen
of India:
(a) Copy of child’s birth certificate
(b) Copy of Indian passport of the parents / one of the parents or copy of the Domicile
Certificate or Nativity Certificate issued by the Competent Authority in respect of the
parents/ one of the parents or any other proof substantiating the status of the parents/ one
of the parents as being Indian citizen(s).
(c) If the parents are divorced, court order of dissolution of marriage, which specifically
mentions that the legal custody of the child is with the parent who is applying for the OCI
card.
File Ref No : USAH01317X19
(F) Evidence as spouse of foreign origin of a citizen of India or spouse of foreign origin of an OCI
Cardholder:
(a) Registered marriage certificate; and
(b) In the case of spouse of an Indian citizen - Copy of the Indian Passport of the spouse or
copy of the Domicile Certificate or Nativity Certificate issued by the Competent Authority
in respect of the Indian spouse or any other proof substantiating the status of the spouse
as being an Indian citizen.
(c) In the case of spouse of an OCI Cardholder - Copy of the present valid Passport of the
spouse and copy of the OCI Card of the spouse and copies of the documents upon which
the OCI Card was issued to the spouse.
(G)
(a) In case of applications submitted to the Indian Mission/ Post abroad, OCI registration fee
of US$ 275 for each applicant in local currency to be paid by way of Demand Draft (till
online payment facility is introduced).
(b) In case of applications submitted in India, a fee of Rs.15,000/- by way of Demand Draft
drawn in favour of “Pay and Accounts Officer (Secretariat), Ministry of Home Affairs”
payable at New Delhi(till online payment facility is introduced).
8. The documents enclosed with the application should be self attested.
9. After submission of the application online along with supporting documents, photograph and signature,
the applicants have to submit the original supporting documents to the Indian Mission/Post/FRRO
concerned for prior verification.
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I. In India to the Foreigners Regional Registration Officer (FRRO), Mumbai, Kolkata, Delhi,
Amritsar, Chennai, Hyderabad, Bangalore, Lucknow, Kochi, Kozhikode, Thiruvananthapuram
(Trivandrum),Ahmedabad and Goa.
II. Outside India, to the Indian Mission/Post having jurisdiction over the country of which the
applicant is a citizen or if he/she is not living the country of his/her citizenship, to the Indian
Mission/Post having jurisdiction over the country of which the applicant is ordinarily resident
10. After receipt of application in concerned office, a File (or Acknowledgement) Number would be issued to
the applicant by way of acknowledgement
11. The applicant can verify the status of his/her application online by quoting the online
Registration Number or File (or Acknowledgement) Number.
12. 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.
13. For collection of OCI document, the applicant is required to be present at the concerned Indian Mission
/ FRRO Office in person or he/she can send a duly authorized person, along with his/her passport &
PIO card (if any) and the original documents for which self-attested copies were attached at the time of
File Ref No : USAH01317X19
submitting application, for verification purposes.
14. 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.
15. 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).
A. For Re-print this application, visit : https://ociservices.gov.in
B. For status Enquiry about your application, visit : https://ociservices.gov.in
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