PAKISTAN ORIGIN CARD 1

1 01
National Database and Registration Authority
Ministry of Interior, Government of Pakistan NADRA
PAKISTAN
Paste your recent Instructions
photograph (a) Read carefully the instruction given at the back before filling the form.
here (b) Form will be rejected if marked fields are left blank.
(c) Use CAPITAL letters to fill the form.
Barcode Sticker
Do not use Pin or Staple
1 Type of Application New Duplicate Renewal Change Cancel
Specify grounds on which you claim your Pakistani Origin (attach proof). More than one ground may be specified

1.5” x 2” 2 By Birth Blood Relatives in Pakistan NIC / Passport Other

Applicant’s Full Name ( First, Middle, Last)

3
Applicant’s NIC / CNIC / POC / NICOP No. Applicant’s Present Nationality (as mentioned on Foreign Passport)
4 5
Father’s Name ( First, Middle, Last)
6
Father’s NIC / CNIC / POC / NICOP No. Father’s Present Nationality
7 8
Mother’s Name ( First, Middle, Last)
9
Mother’s NIC / CNIC / POC / NICOP No. Mother’s Present Nationality
10 11
Spouse’s Name ( First, Middle, Last) (compulsory for married or widowed)
12
Spouse’s NIC / CNIC / POC / NICOP No. Spouse’s Present Nationality (compulsory for married or widowed)
13 14
Applicant’s Place of Birth Date of Birth ( DD / MM / YYYY) Home Delivery
15 16 None
Foreign Passport No. (Non-Expired) Date of Expiry ( DD / MM / YYYY) Pakistan
17 18 Abroad
Extra Rs.50 for Pakistan &
US $ 7 or equivalent for
Name of the Blood Relative Living in Pakistan abroad will be charged.
Te l e p h o n e N u m b e r i s
19 mandatory for Home
Delivery.
Relative’s CNIC / NICOP No. Relation with the Relative
20 21
Fax No. (Country Code - City Code - Fax No.) Telephone No. (Country Code - City Code - Phone No.) E-mail
22
Present Address
*
23

Permanent Address
*
24

In case of Jammu & Kashmir citizen

25 Azad Jammu & Kashmir Migrant from Kashmir Valley Migrant from Jammu Kashmir or Other areas

*26 Gender Religion Profession Education Disability (if any) Applicant’s Left Thumb
Applicant’s Signature
(Do not affix thumb impression and
Male
Muslim** Business Post Graduate
Sight Impression signature together
Christian Engineering Graduate
Female
Qadiani / Medicine Hearing
Marital Status Ahmedi Under Graduate
IT
Hindu Others Speech
Married Management
Parsi Law Employment status Physical
Unmarried
Sikh Labour Salaried
Mental
Divorced Budhist Student Self Employed
Others Others
Widowed Others Dependent

Have you ever been deprived of Pakistani citizenship by an order of the Government of Pakistan? Yes No
27 Have you ever been a citizen / national of India or Israel? Yes No
Any of your parents / grandparents are presently citizen / national of India or Israel? Yes No
Mode of Payment Bank Receipt Bank Draft
Signature or Thumb Impression
28 Bank Receipt / Draft. Deposit Date
Amount
**29 I Solemnly affirm that, I believe completely and unconditionally in the finality of the Prophethood of the
Prophet Muhammad (PBUH), and that I am not a follower of any person who claims Prophethood on the
basis of any interpretation of this word, neither I believe such a claimant to be a reformer or a prophet,
nor I belong to Qadiani or Lahori group or call myself Ahmedi.
 DECLARATION
I hereby solemnly declare and affirm that the information provided and statements made by in this form are true and correct to
the best of my knowledge and belief and nothing material has been concealed or withheld herein. I understand and
accordingly permit that (i) the information provided by me in this form may be stored by NADRA in Pakistan in secure
environment in both physical and/or automated shape and (ii) the information may be used for purposes of planning and
development and statistical analysis by NADRA and./or the Government of Pakistan within the confines of the Constitution of
Islamic Republic of Pakistan 1973 and the applicable Pakistan law without disclosing my specific personal information except
for the purposes of verification of the said information for the purposes of determining my eligibility for POC under Pakistan
Law.

Applicant Signature

INSTRUCTIONS
GENERAL INSTRUCTIONS:

Please fill in the form in BLACK INK and clearly print or type only in CAPITAL letters and avoid contact with the edges of
the box. A block may be left empty wherever a word ends and a new word begins in the same line or where nothing
further is to be written.

Avoid any over-writing and other mistakes while filling in the form. Please make sure the form is filled in as neatly as
possible. If there are too many mistakes in the form, fill in a new form. Exact photocopies of the form are only acceptable
on A4 size paper.

Wherever small choice filed boxes are provided in the form the box adjacent to the appropriate answer is to be ticked
or checked.

Signature or, if illiterate, thumb impression of left hand of the applicant is required (parent/guardian may sign in case of
inability on part of the applicant). Left hand thumb impression is mandatory to be fixed in the “Applicant’s Left Thumb
Impression” box in field 26.

FEE: Fee for POC is United States Dollar One Hundred (US$(US$ 100) for a person 18 years of age or above and United
(US$ 50) for a person less than 18 years of age. In other countries fee may be charged in any other
States Dollar Fifty (US$
applicable currency in a sum equivalent to the above mentioned fee.

VALIDITY: POC shall be valid for a period of 7 years from the date of issuance.

DISCLAIMER: NADRA accepts no responsibility for any error in the card if it is not attributable to office mistake.

. For MODIFICATION/CHANGE IN ALREADY ISSUED POC, please highlight the field (s) which you want to modify.

DOCUMENTS REQUIRED:
1) Bank Receipt / Draft
2) Two Recent Photographs (1.5” x 2”)
3) Photocopy of Self NIC/CNIC
4) Photocopy of Parents/Husband NIC/CNIC/POC
5) Photocopy of Pakistani passport Self/Parents (if available)
6) Photocopy of Foreign Passport (Non-Expired)
7) Birth Certificate
8) Marriage Certificate (For first time registration as married person)
9) Photocopy of NIC/CNIC of Blood relative living in Pakistan (Apply on Blood relative in Pakistan)
10) Original Computerized National Identity Card (If Held)

INSTRUCTIONS ON INDIVIDUAL FIELDS:

Types of application (Field 1): Applicant must tick mark “ ” only one choice.
Names (Field 3 to 12 where applicable): If any of the name is larger than the space provided, you MUST abbreviate it
appropriately as you would like it to appear on the card and should not exceed twenty seven characters in any case
including spaces.
NIC number (Field 4 to 13 where applicable): All numbers must be written without dashes, leave unused spaces BLANK.
Date of Birth (Field 16): If exact date is not known, at least year of birth must be mentioned.
Address (Field 23 & 24): Please fill in complete address as you would like it to appear on the card. Abbreviate longer
names appropriately so that they remain understandable.
E-Mail/Fax (Field 22): Mention either of the two. E-mail will however be preferred. Telephone No. be written in this format:
Country code - City code - Number - Extension.
Field 26: Select appropriate boxes (All headings are mandatory).
Photo, Thumb or Signature: It MUST not exceed allotted space otherwise it will be truncated.
Financials: Fill out payment details in lower right corner of the form and attach original deposit slip/bank draft.

Note: In case not a home delivery, your card will be sent at the concerned Embassy / Card Distribution Point.