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Visa Form

S. 109-A

APPENDIX 1
Para 3(1)(a)
PART-A
(Visa Application)
(TO BE FILLED BY ALL APPLICANTS FOR VISA)

1. (A) Full Name (In Block Letters)


Please affix a Passport
Mr./Mrs./Miss._______________________________ size photograph here.

(b) Surname at birth (if different)______________________


(c) Father’s/Husband’s Name__________________________
2. Whether any children-accompanying applicants are included in his/her passport. If so give
the following details: -
Place and date of Identification
Name Sex Relationship
birth Mark (if any)

3. Address:

a. Permanent

b. Present

4. Date of Birth
5. Place of Birth
6. Present Nationality
7. Any other nationality, previous or present, with dates
8. Profession or Occupation
9. Particulars of passport or other travel documents:-

(a) Number________________ (b) Place of Issue______________________

(c) Date of Issue____________ (d) Date of Expiry______________________

10. Have you visited India previously, if so indicate places with dates____________________
_______________________________________________________________________
11. Whether permission to visit India or to extend stay in India has been refused previously, if
so, when__________________________________________________
12.(a) Period for which visa is required_______________________________________
(Note: Extension of Transit Visas which are valid for three days will not generally be granted.)
(b) Whether a single, double, triple or multiple entry visa is required__________________
13. Object of journey

a. Transit
(Place/country to be visited further)

b. Tourism
(Places/areas to be visited)

c. Business
(Trade/Project/Scheme - Brief description to be given)
(Party/parties to be contacted)

d. Education
(Name and particulars of educational institutions)

e. Any other
PART-B
(NOT TO BE FILLED BY APPLICANTS FOR TOURIST VISAS)

1. Whether holding valid ‘No Objection to return endorsement’, if so, give


particulars____________________________________________________________
2. State, Town, etc. of destination in India_____________________________________
3. Port of landing in India__________________________________________________
4. Name and address of persons who will furnish information as to applicant and also
furnish financial guarantees for maintenance and repatriation if referred to: -

IN COUNTRY OF APPLICANT
(i)
(ii)
IN INDIA
(i)
(ii)

I, _________________________ hereby undertake that I shall utilise my visit to India for the
purpose for which the visa has been applied for and shall not, on arrival in India, try to obtain
employment or set up business or extend my stay for any other purpose.

Date___________ Signature_____________________

(Clarification: There may be variations in forms issued by various Indian Missions - specific
requirements may be obtained from the concerned Mission by the applicant.)