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OF KERALA
RECEIPT FOR ONLINE SUBMISSION OF FORM-C
Reference Code Name of the Foreign Visitor Last Name of the Foreign Visitor Address of the foreign visitor Nationality Date of Birth(Y-m-d) E-mail Address Passport Number Date of Issue of Passport(Y-m-d) Place of Issue of Passport Date of Expiry of Passport(Y-m-d) Visa Type Visa No Date of Issue of Visa(Y-m-d) Place of Issue of Visa Visa Expiry Date(Y-m-d) Date of Arrival in India(Y-m-d) Arrived From Proceeding To Whether employed in India No: of Certificate of Regn,if any Proposed Duration of Stay in India Profession Room No: Purpose of Visit Expected Date of Departure(Y-m-d) District Property Name Form-C Submitted On(Y-m-d) : : : : : : : : : : : : : : : : : : : : : : : : : : : : : 20110706/211660 AHMED IBRAHIM AHMED AKAIH ALNUAIMI ALNUAIMI P B NO 192, RAS AL KHAIMAH, U A E. United Arab Emirates 1942-04-02 Calicutower@yahoo.com A 2527333 2010-10-25 RAS AL KAIMAH 2015-10-24 T AP 2680498 2011-06-12 CGI DUBAI 2011-12-11 2011-07-05 2011-07-05 22:00:00 UAE UAE No N 11/12/2011 MERCHANT 402 TOUR 2011-07-30 KOZHIKODE CALICUT TOWER 2011-07-06 09:39:35

Date&Time of Arrival in Premises(Y-m-d):