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Sample Indian VISA Application Form

This document is a visa application form submitted by Sk Shahidul Islam to the High Commission of India in Dhaka, Bangladesh. It contains personal information such as his name, date of birth, passport details, contact information, family details, and details of the visa being sought, which is a tourist visa for 12 months with multiple entries to India. It also includes information about his occupation, address of where he plans to stay in India, references in both countries, and his declaration confirming the accuracy of the information provided.

Uploaded by

Md Kamruzzaman Khan
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6K views3 pages

Sample Indian VISA Application Form

This document is a visa application form submitted by Sk Shahidul Islam to the High Commission of India in Dhaka, Bangladesh. It contains personal information such as his name, date of birth, passport details, contact information, family details, and details of the visa being sought, which is a tourist visa for 12 months with multiple entries to India. It also includes information about his occupation, address of where he plans to stay in India, references in both countries, and his declaration confirming the accuracy of the information provided.

Uploaded by

Md Kamruzzaman Khan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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HIGH COMMISSION OF INDIA

Paste your unsigned


recent color photograph.
Size: 2 X 2

DHAKA(BANGLADESH)

Visa Application Form

Signature

BGDDV8643216

Previous/other Name if any


Sex

Web Registration Date : 05-MAR-2016

Application Id :BGDDV8643216

Date of birth
Place of Birth Town/City
Citizenship /National ID No
Visible identification marks
Current Nationality

Male
06-JAN-1970
KHULNA
19704793305012650
NIL
BANGLADESH

Marital Status
Religion
Country of Birth
Educational Qualification

Married
ISLAM
BANGLADESH
HIGHER SECONDARY

Nationality by Birth/ Naturalization

BY BIRTH

Date of issue ( dd/mm/yyyy )

17-MAY-2015
16-MAY-2020

Any Other Previous/Past Nationality


B. Passport Details

BF0687952
DHAKA

Passport No.
Place of issue

Date of expiry (dd/mm/yyyy)

Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Country of issue

Place of issue

Passport/IC No

Date of issue(dd/mm/yyyy)

Nationality/status
C. Applicants Contact Details
Present
address

PABLA BANIK PARA,DAULATPUR


DAULATPUR
KHULNA, BANGLADESH 9202

Phone No
Mobile /Cell No

01711584716

Email address

Permanent PABLA BANIK PARA,DAULATPUR


Address
DAULATPUR
KHULNA
D. Family Details
Relation

Name

Nationality

Prev. Nationality

Place/Country of Birth

Fathers

SHAKH SAMIR UDDIN

BANGLADESH

BANGLADESH

KHULNA
BANGLADESH

Mothers

MRS NOOR JAHAN BEGUM

BANGLADESH

BANGLADESH

KHULNA
BANGLADESH

Spouse

MOUSUMI ISLAM

BANGLADESH

BANGLADESH

KHULNA
BANGLADESH

Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO


E. Details of Visa Sought

(Visa shall be valid from the Date of Issue and not from the Date of Journey)

TOURIST VISA
(Month) 12 Month
BY AIR/ HARIDASPUR

Type Of Visa Required


Period of Visa
Port Of Arrival

SK SHAHIDUL ISLAM

No of Entries
Expected Date of Journey
Port of Exit

Multiple
30-APR-2016
BY AIR/ HARIDASPUR

Appointment Date : 14-MAR-2016 At : 11.30

A. Personal Particulars (As in Passport)


Surname (As in Passport)
ISLAM
Given Nam e (As in Passport) SK SHAHIDUL

Required Detail of

TOURIST VISA
KAZIPARA,BARASAT
BARASAT,N 24 PGS.

Purpose of Visit : TOURISM


F. Previous Visit Details
Have You Ever visited India ?
Address where You stayed in
India

NO

Cities in India Visited


Type of Visa
Visa Issued Place
Countries visited in last 10 years

Application Id :BGDDV8643216

Places to be Visited

Visa Number
Date of Issue

Have you been refused an Indian Visa or extension of the same previously or deported from India ?
If yes above mention when and by whom with control
No/Date
G. Profession/Occupation Details
Present Occupation PRIVATE SERVICE
Designation/Rank
Employer name/business SK SHAHIDUL ISLAM
Employer Address DAULATPUR,KHULNA
Phone Number
Past occupation if any
Are/have you worked with Armed forces/ Police/ Para Military forces ? NO
Organization
Designation
Place of Posting
Rank
H. Address of Place of Stay / Hotel
Place/Hotel Name
Address of Place / Hotel

State

Phone No.

1 KAMAL SIKDER KAZIPARA,BARASAT NORTH 24 PARGANAS WEST BENGAL . 00919088666818,


2 .,
3 .,
4 .,
I. Details of Two Reference
In India
In BANGLADESH
Nam e KAMAL SIKDER
SK RUHUL AMIN
Address KAZIPARA,BARASAT
DEANA,EAST PARA,DAULATPUR,
BARASAT,N 24 PGS.

Phone
00919088666818
Number

KHULNA
01715401161

J. DECLARATION:
a.
b.
c.
d.

I do not hold any other passport(s) other than those detailed above.
I have read and understood all the conditions for the visit to India and I am willing and able to abide fully by them.
I declare that the information given in the form is complete and correct and the visit to India will be undertaken for the
purpose indicated in the application.
I understand that in case the information provided in the form is found to be incorrect, I will be liable for denial of visit/ entry
or deportation and/ or other penalties during the visit as provided by Indian law.

05-MAR-2016
Date :.

..
Applicants signature (as in Passport)

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