New Microsoft Word Document 7 - Indian Embassies, India ...

1 Visa Form S. 109-AAPPENDIX 1 Para 3(1)(a) part -A (Visa Application) (TO BE FILLED BY ALL APPLICANTS FOR VISA) 1. (A) Full Name (In Block Letters) (b) Surname at birth (if different)_____ (c) Father s/Husband s Name_____ Please affix a Passport size photograph here. 2. Whether any children-accompanying applicants are included in his/her passport. If so give the following details: - Name Place and date of birth Sex Relationship Identification Mark (if any) 3. Address: a. Permanent b. Present 4.

2 Date of Birth 5. Place of Birth 6. Present Nationality 7. Any other nationality, previous or present, with dates 8. Profession or Occupation 9. Particulars of passport or other travel documents:- (a) Number_____ (b) Place of Issue_____ (c) Date of Issue_____ (d) Date of Expiry_____ 10. Have you visited India previously, if so indicate places with dates_____ _____ 11. Whether permission to visit India or to extend stay in India has been refused previously, if so, when_____ 12.(a) Period for which visa is required_____ (Note: Extension of Transit Visas which are valid for three days will not generally be granted.)

3 (b) Whether a single, double, triple or multiple entry visa is required_____ 13. Object of journey a. Transit (Place/country to be visited further) b. Tourism (Places/areas to be visited) c. Business (Trade/Project/Scheme - Brief description to be given) (Party/parties to be contacted) d. Education (Name and particulars of educational institutions) e. Any other part -B (NOT TO BE FILLED BY APPLICANTS FOR TOURIST VISAS) 1. Whether holding valid No Objection to return endorsement , if so, give particulars_____ 2.

4 State, Town, etc. of destination in India_____ 3. Port of landing in India_____ 4. Name and address of persons who will furnish information as to applicant and also furnish financial guarantees for maintenance and repatriation if referred to: - IN COUNTRY OF APPLICANT (i) (ii) IN India (i) (ii) I, _____ hereby undertake that I shall utilise my visit to India for the purpose for which the visa has been applied for and shall not, on arrival in India , try to obtain employment or set up business or extend my stay for any other purpose.

5 Date_____ Signature_____ (Clarification: There may be variations in forms issued by various Indian Missions - specific requirements may be obtained from the concerned Mission by the applicant.)