1. 2. Name: Father’s/Husband Name: & Occupation: 3. Address: Telephone No. 4. 5. 6. 7. 8. 9. 10. Passport No: Date of Issue: Date of birth: (a) Height Valid upto (a) Place of birth (b) Colour of eyes Issued at Religion (b) Sex (c) Colour of hair: Paste your recent photograph

Occupation (Previous occupation if retired): Do you belong or have belonged to Military/Semi Military, Police org.? Yes/No If answer to either question at S. No. 9 is “Yes” Please state your present / past rank & full name of the organization :

11. 12. 13. 14. S. No.

Date of return from last visit to Pakistan (if any): I will enter within Purpose of visit (give full details): Details of children mentioned in your passport who will be traveling with you: Name Date of Birth Sex days and stay days in Pakistan


Signature/Thumb Impression of Applicant -----------------------------------------------------------------------------------------------------------------------------FOR OFFICIAL USE (a) Visa Issued No. children mentioned at serial No. Darya Ganj.No. 18. Mode of travel: I undertake that during my stay in Pakistan on visa. 14 VISA OFFICER PAKISTAN HIGH COMMISSION NEW DELHI Note: Please print both sides of the visa form on a single sheet Printed by: G. PRINTERS. S. Particulars of persons and places/cities to be visited in Pakistan Name Father’s/Husband’s Name House No. Issue and for stay of Also valid for (b) (c) Authority (if any) Check-Post of Entry/Exit. Phone: 23261393 Mob: 9810181159 2 .C. neither I shall apply for Pakistan citizenship nor will any Pakistani Relation of mine apply for an emergency certificate for me.15. New Delhi. Street/Mohallah Village/ Town Tehsil/ District Telephone Number 16. Request for Entry and Exit from different point (if required) Entry: Exit: By Bus By Air By Train On Foot 17. Specify only if Entry and Exit permitted from different airports Entry: Exit: dated Valid for entry within days from the date of days for places allowed in visa stamped in passport.

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