APPLICATION FORM

( Registration )

200619S1Y5MK

Application ID No. 200619S1Y5MK Final Submission Date Fri Jun 21 10:42:24 IST 2019

FOR OFFICE USE ONLY

Reg. No. S 3 1 3 B G D 2 0 2 0

Personal Details
Surname SAHA
Given Name AURGHYA Paste your
Sex Male Date of Birth 17/08/2001 Height (in cm) 165 Recent passport size
Age as on today Year(s) 19 Month(s) 2 Day(s) 7 photograph here
Place of Birth 11 NO MODON BABU ROAD,MYMENSINGH,BANGLADESH
Father's Name PALASH SAHA
Mother's Name RAMA SAHA
Spouse's Name
Religion HINDU Any Identification mark(s) preferably NIL
visible

Present nationality BANGLADESH Previous nationality

Manner of acquiring present nationality Birth
Date of acquiring present nationality
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 11 NO MODON BABU ROAD,MYMENSINGH SADAR,KOTWALI
City MYMENSINGH Country BANGLADESH

Address intended for longer stay in India (Registration)

Address BC 35 DESHBANDHU NAGAR,BAGUIATI
City/ District BIDHANNAGAR State WEST BENGAL
Pin Code 700059
Phone Number Mobile Number
Any Other Address in India
Address
City/ District State
Pin Code
Phone Number Mobile Number
Email/Occupation/Profession Details
E-Mail Id aurghyasaha@gmail.com
Profession/Occupation STUDENT

Passport Details
Passport Number EA0925351 Place of Issue BANGLADESH, DHAKA
Date of Issue 10/06/2019 Expiry Date 09/06/2024

Visa Details
Visa Number VL2866945 Place of Issue BANGLADESH, MYMENSINGH
Date of Issue 02/06/2019 Expiry Date 01/06/2020
Valid For Multiple Entry Visa Type STUDENT VISA
Special endorsement, if any

Organization/Company/Institute/Hospital Details
Name NORTH POINT SENIOR SECONDARY BOARDING SCHOOL
Address VIP ROAD, NEAR BAGUIATI POLICE STATION, TEGHORIA, BAGUIATI, KOLKATA, WEST BENGAL

Page 1 of 3
 200619S1Y5MK
Application ID No. 200619S1Y5MK

State WEST BENGAL City BIDHANNAGAR

Telephone Number Email ID
Employer EPFO ID Establishment ID
Arrival Details
Place of embarkation/boarding for India HARIDASPUR,BONGAON,BANGLADESH
Date of arrival in India 13/06/2019
Place of disembarkation/arrival in India PETRAPOLE
Mode of Journey Road Flight/ Ship/ Bus/ Train No.
Purpose of visit to India Studies

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 Relationship
Address City
Country Phone Number
Category Missionaries-Student

Military service details

Organisation Designation
Rank Place of Last Posting
Country of Last Posting

Signature of the Applicant

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

Page 2 of 3
 200619S1Y5MK
Application ID No. 200619S1Y5MK

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 from School mentioning Grade, Class, Standard studying in along with the duration of the session

Registration office address

Office Name : FRO BIDHANNAGAR

Address : Bidhannagar, Saltlake
City/District : BIDHANNAGAR
State : WEST BENGAL
Pin Code : 700091
Phone Number : 2343080

Office opening time: 10.30 closing time: 15.30

There is no need to submit hard copy to concerned

FRRO/FRO

Page 3 of 3