ASSISTANT HIGH COMMISSION OF INDIA

KHULNA(BANGLADESH) Paste your unsigned

recent color photograph.
Size: 2” X 2”

Visa Application Form

Signature
BGDKV04BAB20

A. Personal Particulars (As in Passport)

Surname (As in Passport) AMIN
Given Nam e (As in Passport) MD RUHUL
Previous/other Name if any
Sex MALE Marital Status MARRIED
Date of birth 18-SEP-1968 Religion ISLAM
Application Id :BGDKV04BAB20

Place of Birth Town/City KHULNA Country of Birth BANGLADESH

Citizenship /National ID No 5535249758 Educational Qualification HIGHER SECONDARY
Visible identification marks NIL
Current Nationality BANGLADESH Nationality by Birth/ Naturalization BY BIRTH
Any Other Previous/Past Nationality
B. Passport Details
Passport No. BW0322547 Date of issue ( dd/mm/yyyy ) 06-AUG-2018
Place of issue DHAKA Date of expiry (dd/mm/yyyy) 05-AUG-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

29, CHARERHAT MAIN ROAD Phone No 01926309269

Present
address KHULNA GPO, KHALISHPUR Mobile /Cell No 1926309269
KHULNA, BANGLADESH 9000 Email address

Permanent 29, CHARERHAT MAIN ROAD

Address KHULNA GPO, KHALISHPUR
KHULNA

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
KHULNA
Father’s RAMJAN ALI BANGLADESH BANGLADESH BANGLADESH
KHULNA
Mother’s SALEHA BEGUM BANGLADESH BANGLADESH BANGLADESH
KHULNA
Spouse ALEYA BEGUM 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

MD RUHUL AMIN
 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 :BGDKV04BAB20
Cities in India Visited KOLKATA
Type of Visa TOURIST VISA Visa Number VL1428982
Visa Issued Place DHAKA Date of Issue 13-JAN-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 BUSINESS PERSON Designation/Rank PROPRIETOR
Employer name/business NEW MOON HARDWARE AND ELECTRIC
Employer Address B I D C ROAD, KHALISHPUR, KHULNA
Phone Number
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 RAMJAN ALI
Address PATHARGHATA, RAJARHAT 29, CHARERHAT MAIN ROAD
NORTH 24 PGS, WB KHALISHPUR, KHULNA
Phone
00919748693833 01713425058
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)