APPLICATION FORM

( Registration )

220319NA7420

Application ID No. 220319NA7420 Final Submission Date Mon Mar 25 22:43:23 IST 2019

FOR OFFICE USE ONLY

Reg. No. S 0 6 7 B G D 2 0 1 9

Personal Details
Surname RAHMAN
Given Name FARIA Paste your
Sex Female Date of Birth 25/07/1991 Height (in cm) 154 Recent passport size
Age as on today Year(s) 27 Month(s) 8 Day(s) 0 photograph here
Place of Birth BANGLADESH,JESSORE,BANGLADESH
Father's Name KHOLIUR RAHMAN
Mother's Name FAIZUN NESA
Spouse's Name
Religion ISLAM Any Identification mark(s) preferably MOLE UNDER RIGHT EYES
visible

Present nationality BANGLADESH Previous nationality BANGLADESH

Manner of acquiring present nationality Birth
Date of acquiring present nationality 25/07/1991
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 NO

Address of last residence (Outside India)

Address 41/2UTAAR BADDA GULSHAN LINK ROAD DHAKA
City DHAKA Country BANGLADESH

Address intended for longer stay in India (Registration)

Address WAZIDPUR
City/ District GAUTAM BUDDHA NAGAR State UTTAR PRADESH
Pin Code 110025
Phone Number Mobile Number 9547828460
Any Other Address in India
Address
City/ District State
Pin Code
Phone Number Mobile Number
Email/Occupation/Profession Details
E-Mail Id rahman.faria91@gmail.com
Profession/Occupation STUDENT

Passport Details
Passport Number BL0408839 Place of Issue BANGLADESH, JESSORE
Date of Issue 24/07/2016 Expiry Date 23/07/2021

Visa Details
Visa Number VL1847108 Place of Issue BANGLADESH, DHAKA
Date of Issue 18/02/2019 Expiry Date 17/08/2020
Valid For Multiple Entry Visa Type STUDENT VISA
Special endorsement, if any

Organization/Company/Institute/Hospital Details
Name GALGOTIAS UNIVERSITY
Address PLOT-2 SECTOR-17A YAMUNA EXPRESS WAY, GAUTAM BUDH NAGAR

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 220319NA7420
Application ID No. 220319NA7420

State UTTAR PRADESH City GAUTAM BUDDHA NAGAR

Telephone Number Email ID International.office@galgotiasuniversity.edu.in
Employer EPFO ID Establishment ID
Arrival Details
Place of embarkation/boarding for India CCU AIRPORT,CCU AIRPORT,INDIA
Date of arrival in India 17/03/2019
Place of disembarkation/arrival in India KOLKATA AIRPORT
Mode of Journey Air Flight/ Ship/ Bus/ Train No. AI229
Purpose of visit to India Education

Previous Registration Details in India

Registration Number Place of Registration Visa Type Duration From To
Details of family members/attendant/dependents, if any accompanying.
Name Nationality Passport Number Relationship
Person to be contacted in Case of Emergency
Name KHOLIUR RAHMAN Relationship FATHER
Address 146/A NEWRAM KIRSNO ROAD JESSORE City JESSORE
Country BANGLADESH Phone Number 01712265084
Category Missionaries-Student

Military service details

Organisation Designation
Rank Place of Last Posting
Country of Last Posting

Signature of the Applicant

Date_ _ _ _ _ _ _ _ _ _ _ _ _

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 220319NA7420
Application ID No. 220319NA7420

List of mandatory and non mandatory documents

Mandatory Documents.
1. Residence proof : Residence Certificate from Hostel/Updated Form ‘C’ generated by Hotel/Lodge or Registered/Notarized Lease Deed, Utility Bill, Copy of photo-ID of the landlord along
with declaration and Tenant Police Verification

2. Photo : Applicant's Photo

3. Financial resource proof : NRO account details and Scholarship letter, whichever is applicable
4. Visa : Indian Visa
5. Passport : Bio-Data page of Passport along with page bearing last Indian Immigration arrival stamp
6. Bonafide certificate : Bonafide Certificate to be obtained from a UGC or AICTE recognized Institute/College/University mentioning Foreign Students’ Information System (FSIS) No.,
course undertaken, duration of course and e-mail ID of the Institute/College/University

Registration office address

Office Name : FRO Noida Gautam Buddh Nagar

Address : D-133 sector 15 Noida
City/District : GAUTAM BUDDHA NAGAR
State : UTTAR PRADESH
Pin Code : 201301
Phone Number : 2514400

Office opening time: 10.00 closing time: 14.00

There is no need to submit hard copy to concerned

FRRO/FRO

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