Visa Application Form



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Visa Application Form

A. Personal Particulars (As in Passport)
Surname As in Passport)
Given Name As in Passport)
Previous/other Name if any Sex
Marital Status Date of birth
Religion Place of Birth Town/City
Country of Birth Citizenship National ID No
Educational Qualification Visible identification marks Current Nationality
Nationality by Birth Naturalization Any Other Previous/Past Nationality
B. Passport Details Passport No. Date of issue ( dd/mm/yyyy ) Place of issue Date of expiry (dd/mm/yyyy)
Any other Passport/Identity Certificate held (if yes please fill in the following)

Country of issue
Place of issue
Passport/IC No
Date of issue(dd/mm/yyyy)
Nationality/status
C. Applicant’s Contact Details
Phone No Mobile Cell No Present address Email address Permanent Address
D. Family Details
Relation
Name
Nationality
Prev. Nationality
Place/Country of Birth
Father’s Mothers Spouse
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area :
E. Details of Visa Sought
Type Of Visa Required No of Entries Period of Visa Expected Date of Journey Port Of Arrival Port of Exit Paste your unsigned recent color photograph. Size 2” X Signature SARKER
Web Registration Date : 06-JAN-2020
BANGLADESH
SYLHET(BANGLADESH)
( Month)
BY BIRTH
HINDU
BANGLADESH
MITA SARKER
BANGLADESH
BADAL SARKER
ASSISTANT HIGH COMMISSION OF INDIA
HIGHER SECONDARY
18-NOV-1992
TOURIST VISA
NILL
BANGLADESH
1741017877
BY ROAD AGARTALA
SREEMANGAL
RUPOSHPUR
MOULVIBAZAR
MALE
DHAKA
12 Month
BAKUL
BANGLADESH
DHAKA
MOULVIBAZAR, BANGLADESH 3210
SREEMANGAL
RUPOSHPUR
ITZALAMIN@YAHOO.COM
MOULVIBAZAR
31-MAR-2023
BT0217245
DHAKA
Application Id :BGDSV0048120
NO
BANGLADESH
19925818385000549 20-JAN-2020
SINGLE
NO
SARKER
BY ROAD AGARTALA
BANGLADESH
MULTIPLE
01-APR-2018
(Visa shall be valid from the Date of Issue and not from the Date of Journey)
BANGLADESH
Required Detail of Purpose of Visit :
F. Previous Visit Details
Have You Ever visited India ? 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 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
Designation/Rank Employer name/business Employer Address Phone Number Past occupation if any
Are/have you worked with Armed forces Police Para Military forces ? Organization Designation Place of Posting Rank
H. Address of Place of Stay / Hotel
Place/Hotel Name Address of Place / Hotel State Phone Nob I. Details of Two Reference

In India In
Nam e Address Phone Number J. DECLARATION a. I do not hold any other passports) 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.
..…………………………………… Date :………………………. Applicant’s signature (as in Passport)
918974810979
KHUWAI
2 . ,
RUPOSHPUR
SREEMANGAL, MOULVIBAZAR
INDIA
1 HOTEL SONAR TORI RONALDSAY ROAD, AGARTALA WEST TRIPURA WEST BENGAL. +91 381 232 220, info@hotelsonartoriagartala.com
06-JAN-2020
NO
4 . TOURIST VISA
FOR RECREATION,SIGHT SEEING, CASUAL VISIT TO MEET FRIENDS OR RELATIVES, ATTENDING A SHORT TERM YOGA PROGRAMME AND SHORT DURATION MEDICAL TREATMENT INCLUDING TREATMENT UNDER INDIAN SYSTEMS OF MEDICINE 3 . TOURIST VISA
OWNER
VK899041
KOLKATA, WEST BENGAL
AGARTALA
SYLHET
SHEVRE
Application Id :BGDSV0048120
KOLKATA
BUSINESS PERSON
BANGLADESH
KHOMA RANI PAUL
,
Places to be Visited
RADHARANI JEWELLERS
YES
STUDENT
18-APR-2018
BADAL SARKER
SREEMANGAL
+8801717973082


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