GUWAHATI AIRPORT

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e-Visa Application Form

Signature

I019V0022D19

A. Personal Particulars (As in Passport)

Surname KAUR
Given Name JASHMITA JASVINDAR
Previous Name
Gender FEMALE Marital Status SINGLE
Date of Birth 14/11/1997 Religion CHRISTIAN
Place of Birth SUVA Country of Birth FIJI
File Ref No : I019V0022D19

Nationality FIJI
Identification
marks NA
B. Passport Details
Passport No. 1140971 Date of Issue 13/11/2018
Place of Issue SUVA FIJI Date of Expiry 13/11/2028
Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Country of Issue Place of Issue
Passport/IC No. Place of Issue
C. Applicant's Contact Details
Present Address LOURDES STREET ABA HOMES ANTIPOLO RIZAL
Mobile 09475112412 Email YUMEFREND@GMAIL.COM
D. Family Details
Relation Name Nationality Prev. Nationality Place of birth
Father's JAGES SINGH FIJI LAUTOKA FIJI ISLANDS
Mother's PREMA DEVI FIJI BA FIJI ISLAND
Spouse's
Were your Parents/Grandparents (paternal/maternal) Pakistan Nationals or Belong
to Pakistan held area. NO
E. Visa Details
Visa Service eTourist Visa(for 30 Days)
Period of visa 30 days No. of entries Double
Journey Date 20/09/2019 Port of Exit GUWAHATI AIRPORT
 F. Purpose Details
Purpose of Visit RECREATION/SIGHT-SEEING
1) Places to be visited1 TAJ MAHAL
2) Places to be visited2 INDIA GATE
3) Have you booked any room in Hotel/Resort etc. through any
Tour Operator? NO
4) Name of the tour operator
5) Address of the tour operator
6) Name of Hotel/Resort etc
7) Place/City of Hotel/Resort etc
8) Have you ever been arrested/ prosecuted/ convicted by
Court of Law of any country? NO
9) Have you ever been refused entry / deported by any country
including India? NO
10) Have you ever been engaged in Human trafficking/ Drug
trafficking/ Child abuse/ Crime against women/ Economic
File Ref No : I019V0022D19 :: Registration Date :14/SEP/2019

offense / Financial fraud? NO

11) Have you ever been engaged in Cyber crime/ Terrorist
activities/ Sabotage/ Espionage/ Genocide/ Political killing/
other act of violence? NO
12) Have you ever by any means or medium, expressed views
that justify or glorify terrorist violence or that may encourage
others to terrorist acts or other serious criminal acts? NO
13) Have you sought asylum (political or otherwise)in any
country? NO
14) evisa_fee 0
G. Profession/Occupation Details
Present
Occupation UN-EMPLOYED Designation/Rank NA
Employer name/business NA
Employer Address NA Employer Phone
H. Details of Two Reference
In India In FIJI
Name MANOJ KUMAR RONNIE SODUSTA
S-170/515, JHARERA VILLAGE SUVA FIJI
DELHI CANTT NEW DELHI-
Address 110010
Phone +91 9650149200 +697 236477
I. DECLARATION
a. I do not hold any other passport(s) other than those detailed above.
b. I have read and understood all the conditions for the visit to India and I am willing and able to abide fully by them.
c. I declare that the information given in the form is complete and correct and the visit to India will be undertaken for the purpose
indicated in the application.
d. I understand that in case the information provided in the form is found to be incorrect, I will be liable for denial of visit/ entry or
deportation and/ or other penalties during the visit as provided by Indian law.

Date :14/SEP/2019