ASSISTANT HIGH COMMISSION OF INDIA

KHULNA(BANGLADESH) Paste your unsigned

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Visa Application Form

Signature
BGDKV04C0720

A. Personal Particulars (As in Passport)

Surname (As in Passport) RAJIB
Given Nam e (As in Passport) PARVEZ ISLAM
Previous/other Name if any
Sex MALE Marital Status MARRIED
Date of birth 01-JAN-1997 Religion ISLAM
Application Id :BGDKV04C0720

Place of Birth Town/City KHULNA Country of Birth BANGLADESH

Citizenship /National ID No 19974792101007706 Educational Qualification BELOW MATRICULATION
Visible identification marks NIL
Current Nationality BANGLADESH Nationality by Birth/ Naturalization BY BIRTH
Any Other Previous/Past Nationality
B. Passport Details
Passport No. BW0116517 Date of issue ( dd/mm/yyyy ) 16-JUL-2018
Place of issue DHAKA Date of expiry (dd/mm/yyyy) 15-JUL-2023
Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Country of issue Place of issue
Passport/IC No Date of issue(dd/mm/yyyy)
Web Registration Date : 25-FEB-2020

Nationality/status
C. Applicant’s Contact Details

GHOSHGATI Phone No 01797715150

Present
address GOSHGATI BARAKPUR, DIGHALIA Mobile /Cell No 1797715150
KHULNA, BANGLADESH 9203 Email address

Permanent GHOSHGATI
Address GOSHGATI BARAKPUR, DIGHALIA
KHULNA

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
KHULNA
Father’s HEMAYET SHEPAT BANGLADESH BANGLADESH BANGLADESH
KHULNA
Mother’s BEAUTY BEGUM BANGLADESH BANGLADESH BANGLADESH
KHULNA
Spouse GULSHAN ARA BABY BANGLADESH BANGLADESH BANGLADESH
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO
E. Details of Visa Sought (Visa shall be valid from the Date of Issue and not from the Date of Journey)

Type Of Visa Required TOURIST VISA No of Entries MULTIPLE

Period of Visa ( Month) 12 Month Expected Date of Journey 25-MAR-2020
Port Of Arrival BY ROAD GHOJADANGA Port of Exit BY ROAD GHOJADANGA

PARVEZ ISLAM RAJIB

 Required Detail of TOURIST VISA
Places to be Visited KOLKATA

Purpose of Visit : FOR RECREATION,SIGHT SEEING, CASUAL VISIT TO MEET FRIENDS OR RELATIVES, ATTENDING A SHORT TERM YOG
F. Previous Visit Details
Have You Ever visited India ? YES
Address where You stayed in MD LIAKAT HOSSAIN
India
PATHARGHATA, RAJARHAT, NORTH 24 PGS, WB

Application Id :BGDKV04C0720
Cities in India Visited KOLKATA
Type of Visa TOURIST VISA Visa Number VL1865432
Visa Issued Place DHAKA Date of Issue 26-FEB-2019
Countries visited in last 10 years
INDIA
Have you been refused an Indian Visa or extension of the same previously or deported from India ?
If yes above mention when and by whom with control
No/Date
G. Profession/Occupation Details
Present Occupation PRIVATE SERVICE Designation/Rank OFFICE ASSISTANT
Employer name/business ASIF ENTERPRISE
Employer Address JESSORE ROAD, DAULATPUR, KHULNA
Phone Number
01611406706
Past occupation if any
Are/have you worked with Armed forces/ Police/ Para Military forces ? NO
Organization Designation
Place of Posting Rank
H. Address of Place of Stay / Hotel
Place/Hotel Name Address of Place / Hotel State Phone No.
1 PATHARGHATA RAJARHAT NORTH 24 PARGANAS WEST BENGAL. 00919748693833,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India In BANGLADESH
Nam e MD LIAKAT HOSSAIN GULSHAN ARA BABY
Address PATHARGHATA, RAJARHAT GHOSHGATI, GOSHGATI BARAKPUR
NORTH 24 PGS, WB DIGHALIA, KHULNA
Phone
00919748693833 01797715150
Number

J. 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.

..……………………………………
25-FEB-2020
Date :………………………. Applicant’s signature (as in Passport)