Personal Details
Upload Personal Image*
Male    Female    Transgender   
Passport Details
Contact Details
Complete mailing address with Pin Code*
Permanent home address with Pin Code:
Your or your parents place of origin in Punjab/Chandigarh :
PROOF OF INDIAN ORIGIN (PIO or OCI Card):

If applicant does not hold a PIO or OCI card, he/she may provide details of PIO or OCI Card of Mother /Father /Grandfather /Grandmother /Great Grandfather / Great Grand Mother

Complete Name of any one PIO/OCI card holder (either yourself, you father, mother or Grand Father/Grand Mother./ Great Grandfather/ Great Grand Mother

Please attach copy of documentary- Proof of Indian origin* (copy of PIO/OCI Card mentioned above

If you do not have any proof of Punjab Origin, please sign the declaration (last page) and get it attested by the Head or Deputy Head of the Indian Embassy/Consulate

Details of International Medical and Travel Insurance policy for the duration of participation in the CYR (can be provided to Embassy/Consulate after your application is accepted), and at time of travel.

Details of Family/Relative(s) in punjab

Name of your nearest relative/ancestor who migrated from Punjab: if known

Contact Details
Complete mailing address with Pin Code:
Educational & Professional Qualifications

1. Education Qualifications

[Please provide educational qualifications from 10th/Matric onwords]

Educational Qualification Year of Passing Marks(%)/Grade University/College Remarks, If any
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OTHER DETAILS:
Yes
No
Yes
No
Yes
No

I, HEREBY, DECLARE THAT ALL THE INFORMATION GIVEN IN THIS Application Form is true and correct to the best of my information and belief. I also declare that I will abide by the regulations of the Connect With Your Roots programme, would offer my full cooperation in its smooth conduct, and would not leave it mid-way. I declare that I would follow the instructions and programme devised by Government of Punjab and would not leave without permission from competent authority to any other place within or outside Punjab I understand that if I am found guilty of any misconduct or indiscipline during the course of the Programme, Government of Punjab may take the legal action as per the law of land.