HIGH COMMISSION OF INDIA

DHAKA(BANGLADESH) Paste your unsigned

recent color photograph.
Size: 2” X 2”

Visa Application Form

Signature
BGDDW674F819

A. Personal Particulars (As in Passport)

Surname (As in Passport) EHSAN
Given Nam e (As in Passport) SAAD
Previous/other Name if any
Sex MALE Marital Status SINGLE
Date of birth 19-MAR-1992 Religion ISLAM
Application Id :BGDDW674F819

Place of Birth Town/City DHAKA Country of Birth BANGLADESH

Citizenship /National ID No 19923090551116085 Educational Qualification HIGHER SECONDARY
Visible identification marks BIRTH MARK ON LEG
Current Nationality BANGLADESH Nationality by Birth/ Naturalization BY BIRTH
Any Other Previous/Past Nationality
B. Passport Details
Passport No. BP0021551 Date of issue ( dd/mm/yyyy ) 19-APR-2017
Place of issue AGARGAON Date of expiry (dd/mm/yyyy) 18-APR-2022
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 : 24-DEC-2019

Nationality/status
C. Applicant’s Contact Details

21/1, SUKRABAD, MOHAMMADPUR Phone No 01706078450

Present
address DHAKA Mobile /Cell No1706078450
DHAKA, BANGLADESH 1207 Email address SAADEHSAN99@GMAIL.COM

Permanent 21/1, SUKRABAD, MOHAMMADPUR

Address DHAKA
DHAKA

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
BAGERHAT
Father’s MD MAHAMUDUL HAQUE BANGLADESH BANGLADESH BANGLADESH
DHAKA
Mother’s FERDOUSI BEGUM BANGLADESH BANGLADESH BANGLADESH

Spouse

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 15-JAN-2020
Port Of Arrival BY ROAD CHANGRABANDHA Port of Exit BY ROAD CHANGRABANDHA

SAAD EHSAN
 Required Detail of TOURIST VISA
Places to be Visited KOLKATA BANGELURU

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 ? NO
Address where You stayed in
India
,

Application Id :BGDDW674F819
Cities in India Visited
Type of Visa Visa Number
Visa Issued Place Date of Issue
Countries visited in last 10 years
MALAYSIA
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 of Father
Present Occupation STUDENT Designation/Rank RTD GOVERMENT OFFICER
Employer name/business FINANCIAL MANAGEMENT ACADEMY
Employer Address LALASARI, MIRPUR 14
Phone Number
02 871 5399
Past occupation if any RETIRED
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 SHIVA PRAKRUTHI APARTMENT TALACAUVERY LAYOUT JAKKURU BANGALORE KARNATAKA. 01 9743709178, GAURAVJAK@GMAIL.COM
2 .,
3 .,
4 .,
I. Details of Two Reference
In India In BANGLADESH
Nam e GAURAV JAKKENAHALLI MD MAHAMUDUL HAQUE
Address TALACAUVERY LAYOUT JAKKURU 21/1, SUKRABAD, MOHAMMADPUR
BENGALURU KARNATA 560092
Phone
91 9743709178 01916663881
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.

..……………………………………
24-DEC-2019
Date :………………………. Applicant’s signature (as in Passport)