Visa Application Form - ivacbd.com

1 BGDDV1895616 HIGH COMMISSION OF INDIA DHAKA(BANGLADESH) visa Application form Signature Paste your unsigned recent color photograph. Size: 2 X 2 A. Personal Particulars (As in Passport) Surname (As in Passport) Given Name (As in Passport) Previous/other Name if any Sex Date of birth Place of Birth Town/City Citizenship /National ID No Visible identification marks HOSSAIN MAHMUD Male 01-JAN-1975 DHAKA 197512345678111 NA Marital Status Religion Country of Birth Educational Qualification Married ISLAM BANGLADESH GRADUATE Current Nationality BANGLADESH Nationality by Birth/ Naturalization BY BIRTH Any Other Previous/Past Nationality B. Passport Details Passport No. Place of issue XX123458 DHAKA Date of issue ( dd/mm/yyyy ) Date of expiry (dd/mm/yyyy) 03-JAN-2016 02-JAN-2020 Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO Country of issue Passport/IC No Nationality/status C.

2 Applicant s Contact Details A-1,B-2 Place of issue Date of issue(dd/mm/yyyy) Phone No Present address BB----- DHAKA, BANGLADESH 1200 Mobile /Cell No 017111111111 Email address Permanent A-1,B-2 Address BB----- DHAKA D. Family Details Relation Name Nationality Prev. Nationality Place/Country of Birth Father s Mother s Spouse MD XYZ MRS XYZ XYZ BANGLADESH BANGLADESH BANGLADESH BANGLADESH BANGLADESH BANGLADESH DHAKA BANGLADESH DHAKA BANGLADESH DHAKA BANGLADESH Were your Grandfather/Grandmother(Paternal/Materna l) 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 Multiple Type Of visa Required No of Entries Period of visa (Month) Port Of Arrival 12 Month BY AIR/ HARIDASPUR Expected Date of Journey Port of Exit 25-JAN-2016 BY AIR/ HARIDASPUR SURNAME SHOULD BE SAME AS IN PASSPORTMUST BE SAME AS IN PASSPORTGIVE YOUR CURRENT VALID PASSPORT NOMUST BE SAME AS IN UTILITY BILL ADDRESSGIVE YOUR VALID PHONE NUMBER & EMAIL SHOULD NOT BE LEFT BLANKNAME SHOULD BE SAME AS IN PASSPORTPORT SHOULD BE SAMEBOTH PHOTO'S SHOULD BE SAMEAS IN PASSPORTSIGNATURE AS SAME AS IN PASSPORT 6 MONTH Required Detail of Places to be Visited TOURIST visa K Purpose of Visit : TOURISM F.

3 Previous Visit Details Have You Ever visited India ? Address where You stayed in India YES AA BB, CC Cities in India Visited A Type of visa TOURIST visa visa Issued Place DHAKA Countries visited in last 10 years THAILAND,UK,MALAYSIA visa Number Date of Issue VN12345156 01-JAN-2015 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 XYZ Employer Address A B C 123 A Phone Number Past occupation if any 017111111111111 Are/have you worked with Armed forces/ Police/ Para Military forces ? NO Organization Place of Posting H.

4 Address of Place of Stay / Hotel Place/Hotel Name Address of Place / Hotel 1 HOTEL XYZ 9 MA ABC XYZ KOLKATA WEST BENGAL . 0091100000000, 2 . , 3 . , 4 . , I. Details of Two Reference Designation Rank State Phone No. MD XYZ In India In BANGLADESH MD ABC Name Address ROAD NO-111,FLAT-A,ABC LANE, KOLKATA A B C D .. DHAKA BANGLADESH Phone Number +91000000000000 017000000000 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 .

5 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.. 12-JAN-2016 Date :.. Applicant s signature (as in Passport) 6 Application Id :BGDDV1895616 GIVE YOUR PREVIOUS visa NUMBER & ISSUE MUST BE SAME AS IN PASSPORTPLEASE GIVE GENUINE CONTACT DETAILSSHOULD NOT BE LEFT BLANK