+1 780-436-5367
cise@ciseedmonton.com

Life Certificate

		CONSULATE GENERAL OF INDIA 201- 325 Howe Street Vancouver, B.C. Canada V6C IZ7 Phone: 604-662-8811 Fax: 604-609-2031 Website: www.cgivancouver.gov.in Email: indiavisa@telus.net
Life Certificate Registration Form

S. No.

Description

Details

1

Name as in passport/ OCI card/ pension order

2

Date/place of birth (mm/dd/yyyy)

3

Nationality

4

Father/ Husband’s name

5

Address in Canada

6

Phone number (landline)

7

Phone number (mobile)

8

Email ID

9

Passport particulars

Country	:
Number	:
Date of issue (mm/dd/yyyy)	:
Place of issue	:
Valid Till (mm/dd/yyyy)	:

10

Pension payment order/ book number

11

Signature/ thumb impression of the applicant

12

Place of issue of this certificate