APPLICATION FORM

( Visa Extension )

200916R32FP4
Application ID No.
Reg. No.

S

1

Personal Details

Surname
Given Name
Sex
Female
Age as on today
Place of Birth
Father's Name
Mother's Name
Spouse's Name
Religion ISLAM

200916R32FP4
2

Appointment Date

FOR OFFICE USE ONLY

5

I

R

BOOSTANI
MAHDIEH
Date of Birth
21/03/1981
Year(s)
35
Month(s)
,IRAN,NEYSHABOOR,IRAN,NEYSHABOOR,IRAN
ABOLFAZL
AZAM
Any Identification mark(s) preferably
visible

Present nationality
IRAN
Manner of acquiring present nationality
Birth
Date of acquiring present nationality
21/03/1981
Whether holding dual
NO
nationality? If yes,
Name of the country of second nationality
provide the following:Passport No. of second country
Date of Issue
Date of Expiry
Whether travelled on this passport earlier to
India

Whether person of Indian Origin

Address of last residence (Outside India)

29/09/2016

NO

N

Height (in cm)
5
Day(s)

0

1

6

Paste your
Recent passport size
photograph here

163
30

NA
Previous nationality

IRAN

Aadhar Number

Address
City

H NO 21/KHAYAM 14/ FARHANGIYAN TOWN
NEYSHABOOR

Address
City/ District
Pin Code
Phone Number

SIDDHART GUESTHOUSE HNO.27/35-9, RAVINDRAPURI EXTENSION
VARANASI
State
221005
Mobile Number

Address intended for longer stay in India (Registration)

2

Country

IRAN

UTTAR PRADESH

Any Other Address in India

Address
City/ District
Pin Code
Phone Number

State

Email/Occupation/Profession Details

Mobile Number

E-Mail Id
mahdieh_boostani@yahoo.com
Profession/Occupation
STUDENT

Passport Details

Passport Number
Date of Issue

Visa Details

Visa Number
Date of Issue
Valid For

J26980920
09/06/2013

VI4753263
07/07/2013
Multiple Entry

Place of Issue
Expiry Date

IRAN, IRAN
09/06/2018

Place of Issue
Expiry Date
Visa Type

IRAN, COSULATE OF INDIA BANDARABBAS IRAN
06/07/2016
RESEARCH OR TRAINING VISA

TEHRAN IRAN. Whether previously in India? Whether permission to stay in India has been previously refused? Whether permission to extend stay in India has been previously granted? Period of Extension requried Year(s) 1 Month(s) Reason for extension COMPLETING MY STUDY In case of Missionary . Previous Registration Details in India Registration Number Appointment Date YES Current Registration No. if any accompanying. 200916R32FP4 200916R32FP4 State UTTAR PRADESH Telephone Number Employer EPFO ID City Email ID Establishment ID Arrival Details Place of embarkation/boarding for India Date of arrival in India Place of disembarkation/arrival in India Mode of Journey Air Purpose of visit to India Studies Place of Registration Nationality Person to be contacted in Case of Emergency Name Address Country Category Organisation Rank Country of Last Posting Are you registered in current locality FRRO/FRO in the current visit? Have you got extended visa in current visit in current locality FRRO/FRO? Visa Extension Details Passport Number To Relationship Designation Place of Last Posting Current Registration Details Current Extension Details Duration From Relationship City Phone Number Others Military service details VARANASI Visa Type Details of family members/attendant/dependents. Name 29/09/2016 IKA TEHRAN IRAN.IRAN 22/08/2014 DELHI Flight/ Ship/ Bus/ Train No. UP12VEFIRN1172016 Current Extension No.Nature of work Signature of the Applicant Date_ _ _ _ _ _ _ _ _ _ _ _ _ 0 Day(s) 0 .Application ID No.

Office. letter from sponsoring authority etc. 1. 1. 200916R32FP4 200916R32FP4 Appointment Date 29/09/2016 List of mandatory and non mandatory documents Mandatory Documents. or copy of money transaction/ transfer.00 closing time: 17. Non mandatory Documents. Photo : Applicants Photo 2. 3. Residence proof : Form C copy from Hotel or Lodge/ Electricity bill/ Landline/ Telephone /Municipal Bill of the landlord in case of staying in a house of relative or friend along with a letter and photo-id card of the landlord.In case of rented accommodation copy of Lease and Licence agreement (1st and last page and page containing its validity).I. Kotwali Campus. Financial resource proof : Bank statement.U. Varanasi VARANASI UTTAR PRADESH 221002 2502655 Office opening time: 10.00 Applications are accepted upto: 15. RC/RP : Registration Certificate/ Residential Permit.00 . 3.visa with endorsement. Registration office address Office Name Address City/District State Pin Code Phone Number : : : : : : FRO VARANASI L. Form S/ Bonafide certificate : Form S/ Bonafide certificate. 2. Passport and Visa : Photo page. Madagin. 4. page bearing arrival stamp of Indian immigration. page indicating validity.Application ID No. Others : if document type is not in the list.