Appendix XIII Government of India - immihelp

1 Appendix xiii Government of India Ministry of Home Affairs (a) Request for Special Permit (For Protected Areas) Photograph Name of Applicant: _____ Fathers Name:_____ Honorifics (Dr, Mr, Mrs):_____ Surname at birth; if different:_____ Place and Date of birth (Your town and country): _____ Nationality: (a) Present:_____ (b) Past if different and till which date:_____ (c) Reason for change:_____ Occupation:_____ Permanent Address: _____ _____ Mailing Address in India , in any: _____ _____ References: (a) In country of applicant:_____ (b) India :_____ Passport Details: Number:_____ Issued by:_____ At:_____ Valid up to:_____ Details of visa for India , if any obtained: Issued by:_____ Number:_____ Valid up to:_____ Places proposed to be visited:_____ _____ Route intended to be follow:_____ _____ Purpose of visit:_____ Likely date of visit:_____ Likely duration of visit.

2 _____ Is anyone accompanying the applicant?_____ If so, please give details:_____ _____ Arrangements for travel and accommodation that may have been made: _____ _____ Details of previous visits to India :_____ _____ Have you ever previously visited any restricted/protected areas in India ?_____ If so, please give details of the places visited and the dates visited: _____ Has any earlier request for permits been refused?_____ If so, please furnish details:_____ _____ Declaration The information given above is correct and complete to the best of my knowledge. _____Signature of Applicant 1. This application is to be sent to the Ministry of Home Affairs, New Delhi. 2.

3 It is advisable to make the application at least eight weeks ahead of the date of the proposed visit. 3. Applicants outside India are expected to route their applications through the nearest Indian Diplomatic or Consular-Missions.