CONSULATE GENERAL OF PAKISTAN - Passport Rush

1 STAPLE PHOTO HERE visa APPLICATION FORM CONSULATE GENERAL OF PAKISTAN 12 EAST 65TH STREET NEW YORK NY 10065 TEL: (212) 879 5800 FAX: (212) 517 6987 (IF ANY OF THE PARTICULARS FURNISHED ARE FOUND TO BE INCORRECT OR IF ANY INFORMATION IS FOUND TO HAVE BEEN WITHHELD THE visa IS LIABLE TO BE CANCELLED AT ANY TIME) 1 FULL NAME: FIRST MIDDLE LAST 2 SURNAME AT BIRTH IF DIFFERENT 3 PERMANENT ADDRESS 4 PRESENT ADDRESS 5 DATE OF BIRTH PLACE OF BIRTH (DD/MMM/YYYY) (CITY, STATE, COUNTRY) 6 PHONE FAX EMAIL ) 7 Passport NO.

2 Passport ISSUING COUNTRY PLACE OF ISSUE DATE OF ISSUE DATE OF EXPIRY (CITY, STATE, COUNTRY) (DD/MMM/YYYY) (DD/MMM/YYYY) 8 PRESENT NATIONALITY PREVIOUS NATIONALITY 9 FATHER S NAME FATHER S NATIONALITY 10 SPOUSE NAME SPOUSE NATIONALITY 11 HAVE YOU EVER BEEN A CITIZEN OF PAKISTAN PROFESSION OR OCCUPATION 12 TYPE OF visa REQUIRED (PLEASE TICK) Tourist ___ Business ___ Student ___ Entry ___ Transit ___ Journalist ___ Conference ___ Employment ___ Transfer ___ Other _____ 13 PERIOD OF visa 15 Days _____ Six Months _____ One Year _____ Five Year _____ Other _____ FOR OFFICIAL USE ONLY Page 1 of 2 14 EXPECTED DATE OF DEPARTURE FROM USA EXPECTED DATE OF ARRIVAL IN PAKISTAN 15 PURPOSE OF JOURNEY PORT OF LANDING IN PAKISTAN 16 PROVINCE, TOWN.

3 CITY OF DESTINATION IN PAKISTAN 17 ADDRESS IN PAKISTAN 18 NAME AND ADDRESSES OF PERSONS(S) WHO WILL FURNISH INFORMATION ABOUT THE APPLICANT, AND ALSO FURNISH FINANCIAL GUARANTEES FOR REPATRIATION IF REQUIRED 1 2 3 19 WHETHER PREVIOUSLY RESIDING IN PAKISTAN AND IF SO PLACE OF RESIDENCE WITH DATES 20 WHETHER PERMISSION TO VISIT PAKISTAN HAS PREVIOUSLY BEEN REFUSED IF SO, WHEN? 21 WHETHER APPLICATION FOR GRANT OF visa HAS BEEN SUBMITTED TO ANY OTHER PAKISTAN visa ISSUING AUTHORITY? 22 I HEREBY UNDERTAKE THAT I SHALL UTILIZE MY VISIT TO PAKISTAN FOR THE PURPOSE FOR WHICH THE visa HAS BEEN APPLIED. DATE Prepared By: Machine Readable Passport Section, CONSULATE GENERAL of PAKISTAN , New York INSTRUCTION visa application form must filled in all respect.

4 visa fee is US$ (Money Order) for US Citizen only. The issuance of visa is subject to the instructions of Government of PAKISTAN . visa fee is non-refundable, if visa application is processed. If visa application is submitted through mail, self addressed prepaid envelope is mandatory. (USPS Express Mail only for urgent items) Note: 5 year multiple entry visa will be issued to the PAKISTAN Origin US citizens on production of previous Pakistani Passport or CNIC. For children born in the US, father s Pakistani Passport or CNIC is required. Page 2 of 2