While state-level sister-state relationships exist (such as Kerala's 2019 memorandum of understanding with **Wakayama Prefecture, Japan** for cooperation in tourism and agriculture), specific sister city relationships are handled at the municipal level:
* **Kochi:** Twinned with **Menlo Park** (California, USA) and **Pyatigorsk** (Russia). * **Thiruvananthapuram:** Maintains a sister city relationship with **Galveston** (Texas, USA).