PAKISTAN HIGH COMMISSION

2/50-G, SHANTIPATH, CHANAKYAPURI, NEW DELHI

1. 2. Name: Fathers/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

15. S.No.

Particulars of persons and places/cities to be visited in Pakistan Name Fathers/Husbands Name House No. 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. 18.

Mode of travel:

I undertake that during my stay in Pakistan on visa, neither I shall apply for Pakistan citizenship nor will any Pakistani Relation of mine apply for an emergency certificate for me.

Signature/Thumb Impression of Applicant -----------------------------------------------------------------------------------------------------------------------------FOR OFFICIAL USE (a) Visa Issued No. Issue and for stay of Also valid for (b) (c) Authority (if any) Check-Post of Entry/Exit, 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. children mentioned at serial No. 14

VISA OFFICER PAKISTAN HIGH COMMISSION NEW DELHI Note: Please print both sides of the visa form on a single sheet Printed by: G.C. PRINTERS, Darya Ganj, New Delhi. Phone: 23261393 Mob: 9810181159 2