Please submit a Photo (Photo must be in JPG format): Maximum photo size limit is 50 KB

Particulars Fields to be filled

Surname

Given Name *

Male

Sex * Female

Transgender

Date of Birth Date Format * DD/MM/YYYY

Date of Birth (As per the passport)

Crew

Diplomat Exempted

Emergency Transit

Loss of Passport

Newly Born

OCI (Overseas Citizen of India)

Special Category *
Official Exempted

Other Exempted

Others (for General category)

PIO (Person of Indian Origin)

Refugee

TLP

Nationality *

Address in country where residing permanently (As per the

passport)

City *

Country *

Country where residing permanently

CISV Building and Kaizen Guest House, City Montessori

Address/Reference in India
School, LDA Colony, Kanpur Road

State * Uttar Pradesh

City/District * Lucknow
Pin Code * 226012

Passport No *

City Name:
Place of issue of passport*
Country Name:

Date of issue * (DD/MM/YYYY)

Valid till* (DD/MM/YYYY)

Visa No *

In case of CREW/TLP provide CREW/TLP Details

In case of OCI provide details of visa with “U” Sticker on visa

page issued by Indian Mission/Post and for PIO details of

PIO card to be entered

City:
Place of issue *
Country:

Date of issue* (DD/MM/YYYY)

Valid till * (DD/MM/YYYY)

Type of visa * Attendant Medical

Business Visa

Conference Visa

Diplomatic Visa

eBusiness Visa

eMedical Visa

Employment Visa

Entry Visa

eTourist Visa

Film Visa

Intern Visa

Journalist Visa

Long Term Visa

Medical Visa

Misc SP Permission

Missionary Visa

Mountaineering Visa
 OCI

Official Visa

Pilgrim’s Visa

PIO Card Holder

Project Visa

Research or Training Visa

Student Visa

Temporary Landing Permit

Tourist Visa

Transit Visa

United Nations

Visit Visa

Arrived from Country *

Arrived from City * (City/ Place of above country)

Arrived from Place *

Date of Arrival in India * (DD/MM/YYYY)

Date of Arrival in Guest House * (DD/MM/YYYY)

Time of Arrival in Guest House (24 Hrs format)

Intended duration of stay in Guest House * (No. of Days)

Yes
Whether employed in India *
No

Purpose of Visit * (Choose appropriate options) Accompanying parents

Accompanying patients

Accompanying patient as doctor

Accompanying Spouse

Business

Diplomatic

Education

Employment

Internship

Joining Spouse
 Journalism

Medical Treatment of Self

Meeting Friends / Relatives

Minor Child (either parent is Indian)

Official

Others

Seminar Conference in India

Studies

Surrogacy

Tourism

Inside India
Next Destination whether India or Outside India
Outside India

State:

Please fill if next destination is inside India City/District:

Place:

Country:

Please fill if next destination is outside India City:

Place:

Contact Phone No (In India)

Mobile No (In India)

Contact Phone No (Permanently residing Country)

Mobile No (Permanently residing Country)

Remarks (Endorsement on the visa page by the

Embassy/High commission of India)

Please attach one passport size photograph, copy of passport and the valid
Indian Visa page (all in JPEG format)
Visa type and abbreviation
A
bb
Type re
of visa vi
ati
on
Diplo
D
mat
Officia
O
l
UN
U
Officia
D
l
Transi
TR
t
Entry X
Touris
T
t
Emplo
E
yment
Projec
P
t
Stude
S
nt
Journa
J
list
Busine
B
ss
Missio
M
nary
Moun
tainee X
ring
Confer
ence/
Semin
C
ar/
Meeti
ng
Resea
R
rch
Medic M
al ED
Medic
M
al
ED
Atten
X
dant
Univer
U
sal