SerialNo..

DepartmentofPosts
GovernmentofIndia

ApplicationforPostOfficeIdentityCard
(PleasewriteinBLOCKLETTERS)
1.

Nameoftheapplicant

Pleaseaffix
recentstamp
sizecolour
photo

2.

NameofFather/Husband/Guardian

3.

DateofBirth(dd/mm/yyyy)

4.SignatureoftheApplicant(Pleasesigninthebox)

5.

PresentpostaladdresswithPIN

6.

PermanentpostaladdresswithPIN

7.

Datesinceresidingattheaddressatserial5(dd/mm/yyyy)

8.
If you are a tenant, please furnish particulars (name, address/telephone number/mobile
number/emailid)ofthelandlord

9.
Particulars of Employment identity (if employed).Pleaseattach photocopy of ID card issued by
theemployer

10.

AddressoftheemployerwithPIN:

11.
Personalparticulars

TelephoneNo.withareacodeMobilenumber

Personalmarksofidentification

BloodGroup

12.
HaveyouappliedforPOIDearlier:
Yes
No

a.
Statusoftheapplication:Cardissued/cardnotissued

b.
IfCardissued,statusoftheCard:

13.
FeePrescribed:Rs.______

Certifiedthattheinformationfurnishedaboveistruetobestofmyknowledge.ThePOIDcardissuedon
thebasisofthisapplicationimposesnolegalliabilityonIndiaPost.Iftheaddressgivenisfoundfalseor
bogusornotverifiabletheprocessingfeesubmittedmaybeforfeitedbyIndiaPost.

Place:__________________

Date:___________________

________________________

(SignatureoftheApplicant)

(FOROFFICEUSEONLY)

ReceiptNo.
forRs.______

Date

_________________________________________
SignatureofthePAreceivingtheApplication&Fees

Detailsverified.POIDcardmaybeissued/notbeissued.
_______________________________________
(Name,Signature&StampoftheVerifyingOfficial)
Dated:______________________

POIDCardmaybeissued/notbeissuedbasedonthe
_______________________________________
(Name,Signature&StampofthePostmaster)
Dated:______________________

SerialNooftheCardissued

DateofIssue

_______________________________________
(Name,Signature&StampofPostmaster)