Ministry of Home Affairs

APPLICATION FORM FOR VISA RELATED SERVICES

Please fill in particulars in CAPITAL LETTERS (in English) and submit this in Visa
Facilitation Centre in Jaisalmer House, Man Singh Road, New Delhi.
Note : Attach photocopy of Passport and visa pages and also essential documents in support of
request.

PART A
1.

Name (Mr/Mrs/Ms)

2.

Husbands/Fathers Name :

3.

Date of birth

4.

Nationality

:
NUMBER

5.

VALID
FROM

Passport
NUMBER

6.

Visa

7.

Address in India

TYPE

VALID

From

TO

DATE OF ENTRY

RESTRICTED FOR

To

PART B
I require the following service ( Please v against Col. 3 as applicable and X rest Cols.
Also fill Col. 2
1
2
3
i)
Visa extension upto (with conversion to ___________type visa)
ii)
Regularisation of overstyal from (indicate date)
iii) Permission to exit by (indicate date)
iv) Endorsement of visa in new passport obtained while in India
From
To
(Indicate date of issue of Passport and upto which date visa
required)
From
To
*
v) Permission to change port of exit
vi)

**

From

Permission to change mode of travel

To

vii) **Permission to visit additional places (indicate names of places)

* Applicable to Bangladesh nationals.
** Applicable to Pak nationals.

( Signature of applicant with date )

-: 2 :Government of India
Ministry of Home Affairs
(Foreigners Division)
( For office use )

Subject to usual checks and no local objection, the following change may be endorsed on the
applicants current passport :i)
ii)
iii)
iv)
v)
2.

Extension of visa from ______________ to ________________.

Conversion of visa from ______________type to ____________type.
Permit exit by ______________________.
Permit Port change to _________________.
Endorse visa in New Passport.

This issues with the approval of the competent authority.

(Signature & Seal of issuing Authority)

F.R.R.O/F.R.O.,___________________________________________________________________
dtd.
MHA U.O. No.

Ministry of Home Affairs

APPLICATION FORM FOR VISA RELATED SERVICES
Please fill in particulars in CAPITAL LETTERS (in English) and submit this in Visa
Facilitation Centre in Jaisalmer House, Man Singh Road, New Delhi.
Note : Attach photocopy of Passport and visa pages and also essential documents in support of
request.

PART A
1.

Name (Mr/Mrs/Ms)

2.

Husbands/Fathers Name :

3.

Date of birth

4.

Nationality

:
NUMBER

5.

VALID
FROM

Passport
NUMBER

6.

Visa

7.

Address in India

TYPE

VALID

From

TO

DATE OF ENTRY

RESTRICTED FOR

To

PART B
I require the following service ( Please v against Col. 3 as applicable and X rest Cols.
Also fill Col. 2
1
2
3
i)
Visa extension upto (with conversion to ___________type visa)
ii)
Regularisation of overstyal from (indicate date)
iii) Permission to exit by (indicate date)
iv) Endorsement of visa in new passport obtained while in India
From
To
(Indicate date of issue of Passport and upto which date visa
required)
From
To
*
v) Permission to change port of exit
vi)

**

From

Permission to change mode of travel

To

vii) **Permission to visit additional places (indicate names of places)

* Applicable to Bangladesh nationals.
** Applicable to Pak nationals.

( Signature of applicant with date )

-: 2 :Government of India
Ministry of Home Affairs
(Foreigners Division)
( For office use )

Subject to usual checks and no local objection, the following change may be endorsed on the
applicants current passport :v)
vi)
vii)
viii)
v)
2.

Extension of visa from ______________ to ________________.

Conversion of visa from ______________type to ____________type.
Permit exit by ______________________.
Permit Port change to _________________.
Endorse visa in New Passport.

This issues with the approval of the competent authority.

(Signature & Seal of issuing Authority)

F.R.R.O/F.R.O.,__________________________________________________________________
MHA U.O. No.
dtd.
Space for internal noting and orders (on duplicate copy)