HIGH COMMISSION OF INDIA

DHAKA(BANGLADESH) Paste your unsigned

recent color photograph.
Size: 2” X 2”

Visa Application Form

Signature
BGDDV2640619

A. Personal Particulars (As in Passport)

Surname (As in Passport) PAUL
Given Nam e (As in Passport) RONI CH
Previous/other Name if any
Sex MALE Marital Status SINGLE
Date of birth 10-JUN-1986 Religion HINDU
HABIGANJ BANGLADESH
Application Id :BGDDV2640619

Place of Birth Town/City Country of Birth

Citizenship /National ID No 19863617143155852 Educational Qualification POST GRADUATE
Visible identification marks BIRTH MARK ON RIGHT HAND
Current Nationality BANGLADESH Nationality by Birth/ Naturalization BY BIRTH
Any Other Previous/Past Nationality
B. Passport Details
Passport No. BY0246390 Date of issue ( dd/mm/yyyy ) 13-DEC-2018
Place of issue DHAKA Date of expiry (dd/mm/yyyy) 12-JAN-2023
Any other Passport/Identity Certificate held (if yes ,please fill in the following) YES
Country of issue BANGLADESH Place of issue DHAKA
Passport/IC No BB0636847 Date of issue(dd/mm/yyyy) 14-JUL-2014
Web Registration Date : 30-JAN-2019

Nationality/status BANGLADESH
C. Applicant’s Contact Details

33/13 BLOCK C,TAJMAJAL ROAD Phone No

Present
address MOHAMMADPUR Mobile /Cell No1714619211
DHAKA, BANGLADESH 1207 Email address RONI99EU@GMAIL.COM

Permanent CHHATIAIN
Address MADHABPUR
HABIGANJ

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
HABIGANJ
Father’s HIRENDRA CH PAUL BANGLADESH BANGLADESH BANGLADESH
HABIGANJ
Mother’s HENA RANI PAUL 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 13-FEB-2019
Port Of Arrival BY ROAD DAWKI Port of Exit BY ROAD DAWKI

RONI CH PAUL
 Required Detail of TOURIST VISA
Places to be Visited SHILLONG
KOLKATA

Purpose of Visit : INDIVIDUAL TOURIST

F. Previous Visit Details
Have You Ever visited India ? NO
Address where You stayed in
India
,

Application Id :BGDDV2640619
Cities in India Visited
Type of Visa Visa Number
Visa Issued Place Date of Issue
Countries visited in last 10 years

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 SENIOR EXECUTIVE
Employer name/business MJL BANGLADESH LIMITED
Employer Address CWS 9, GULSHAN 1, DHAKA 1212
Phone Number
1708124147
Past occupation if any PRIVATE SERVICE
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 HOTEL POINISUK LAITUMKHRAH MAIN ROAD, SHILLONG NOT KNOWN MEGHALAYA. 0364-7100030,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India In BANGLADESH
Nam e NARESH JUNEJA EFFAR ARA KABIR
Address GARGI,BEGHATI,BHADRESWAR HOOGHLY HOUSE 12,ROAD 7
GULSHAN 1, DHAKA 1212
Phone
919830029575 01709654348
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.

..……………………………………
30-JAN-2019
Date :………………………. Applicant’s signature (as in Passport)