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Visa Application Form

Signature

GBRLV0157324

A. Personal Particulars (As in Passport)

Surname (As in Passport) WORRELL
Application Id : GBRLV0157324

Given Name (As in Passport) ROBERT GEORGE

Previous/other Name if any Not Applicable
Gender MALE Marital Status MARRIED
Date of Birth 11-MAR-1958 Religion CHRISTIAN
Place of Birth Town/City LONDON Country of Birth UNITED KINGDOM
Citizenship /National ID No NA Educational Qualification HIGHER SECONDARY
Visible identification marks NONE
Current Nationality Nationality by Birth/
UNITED KINGDOM Naturalization BY BIRTH
Any Other Previous/Past Nationality Not Applicable
B. Passport Details
Passport No. 559326498 Date of Issue ( dd/mm/yyyy ) 15-MAR-2019
Place of Issue HMPO Date of Expiry ( dd/mm/yyyy ) 15-MAR-2029
Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Country of Issue Place of Issue
Web Registration Date : 07-MAR-2024

Passport/IC No. Date of issue (dd/mm/yyyy)

Nationality/Status
C. Applicant's Contact Details
Present 82A BUCKINGHAM ROAD Phone No
Address BRIGHTON Mobile /Cell No 4407500041166
EAST SUSSEX, UNITED KINGDOM
BN1 3RB Email address [email protected]

Permanent 82A BUCKINGHAM ROAD

Address BRIGHTON
EAST SUSSEX

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
LONDON
Father's ROBERT MICHAEL WORRELL UNITED KINGDOM UNITED KINGDOM UNITED KINGDOM
LONDON
Mother's CATHERINE MARGARET WORRELL UNITED KINGDOM UNITED KINGDOM UNITED KINGDOM
LONDON
Spouse GRACE CAROLINE WORRELL UNITED KINGDOM UNITED KINGDOM UNITED KINGDOM
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO

ROBERT GEORGE WORRELL

E. Details of Visa Sought (Visa shall be valid from the Date of Issue and not from the Date of Journey)
Type Of Visa Required TOURIST VISA No of Entries SINGLE
Period of Visa ( Month) 1 Month Expected Date of Journey 13-MAR-2024
Port Of Arrival GOA Port of Exit GOA
Required Detail of TOURIST VISA
Places to be Visited GOA

Purpose of Visit : TOURISM,RECREATION,SIGHT-SEEING

F. Previous Visit Details
Have You Ever visited India ? NO
Address where You stayed in
India ,
Cities in India Visited
Type of Visa Visa Number
Visa Issued Place Date of Issue
Countries visited in last 10 years MEXICO CANADA POLAND GREECE SPAIN
Have you been refused an Indian Visa or extension of the same previously or deported from India ? NO
G. Profession/Occupation Details :
Present Occupation POSTMAN Designation/Rank

Application Id : GBRLV0157324
Employer name/business ROYAL MAIL
Employer Address BRIGHTON DELIVERY OFFICE BN1 1AA
Phone Number 447510608606
Past occupation if any OTHERS
Are/have you worked with Armed forces/ Police/ Para Military forces ? NO
Organization Designation
Place of Posting Rank
H. Details of Two Reference
In India In UNITED KINGDOM
Name O PESCADOR LOUISE WORRELL
Address DONA PAULA JETTY ROAD 17A BATH STREET
NORTH GOA GOA BRIGHTON BN1 3TB
Phone Number 91775940102 447510608606
J. DECLARATION
a. I do not hold any other passport(s) other than those detailed above.
b. I have read and understood all the conditions for the visit to India and I am willing and able to abide fully by them.
c. 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.
d. 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.
e. I will also submit hard-copy all the uploaded documents along with the print of application to submit to the concerning Indian Mission or
Agency for processing of visa application.

07-MAR-2024 ................................
Date : ...................... Applicant's signature (as in Passport)