BENGALURU AIRPORT

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e-Visa Application Form

Signature

I085V0A9EE23

A. Personal Particulars (As in Passport)

Surname POPA
Given Name MIHAI CRISTIAN
Previous Name
Gender MALE Marital Status SINGLE
Date of Birth 22/01/1992 Religion CHRISTIAN
Place of Birth BUCHAREST Country of Birth ROMANIA
File Ref No : I085V0A9EE23

Nationality ROMANIA
Identification
marks NO
B. Passport Details
Passport No. 063486312 Date of Issue 22/02/2023
Place of Issue DAMBOVITA Date of Expiry 22/02/2033
Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Country of Issue Place of Issue
Passport/IC No. Place of Issue
C. Applicant's Contact Details
Present Address SALCUTA, NR.279 TITU DAMBOVITA
Mobile +40726895726 Email CRISTIAN.POPA@HP.COM
D. Family Details
Relation Name Nationality Prev. Nationality Place of birth
Father's MARIAN POPA ROMANIA ROMANIA BUCHAREST
Mother's NICULINA POPA ROMANIA ROMANIA BUCHAREST
Spouse's
Were your Parents/Grandparents (paternal/maternal) Pakistan Nationals or Belong
to Pakistan held area. NO
E. Visa Details
Visa Service eTourist Visa(for 1 Year)
Period of visa 365 days No. of entries Multiple
Journey Date 30/03/2023 Port of Exit BENGALURU AIRPORT
 F. Purpose Details
Purpose of Visit RECREATION/SIGHT-SEEING
1) Places to be visited1 BANGALORE
2) Places to be visited2
3) Have you booked any room in Hotel/Resort etc. through any
Tour Operator? NO
4) Name of the tour operator
5) Address of the tour operator
6) Name of Hotel/Resort etc
7) Place/City of Hotel/Resort etc
8) Have you ever been arrested/ prosecuted/ convicted by
Court of Law of any country? NO
9) Have you ever been refused entry / deported by any country
including India? NO
10) Have you ever been engaged in Human trafficking/ Drug
trafficking/ Child abuse/ Crime against women/ Economic
File Ref No : I085V0A9EE23 :: Registration Date :09/MAR/2023

offense / Financial fraud? NO

11) Have you ever been engaged in Cyber crime/ Terrorist
activities/ Sabotage/ Espionage/ Genocide/ Political killing/
other act of violence? NO
12) Have you ever by any means or medium, expressed views
that justify or glorify terrorist violence or that may encourage
others to terrorist acts or other serious criminal acts? NO
13) Have you sought asylum (political or otherwise)in any
country? NO
14) evisa_fee 40
G. Profession/Occupation Details
Present
Occupation WORKER Designation/Rank
Employer name/business HP INC ROMANIA
Employer Address FABRICA DE GLUCOZA NR5 Employer Phone
H. Details of Two Reference
In India In ROMANIA
Name BIJESH MACHINGAL POPA MARIAN
SLV PLATINUM, FLAT # 409,
VINAYAKA NAGAR, 5TH MAIN,
BAGLUR CROSS, YELAHANKA,
BENGALURU, KARNATAKA,
INDIA SALCUTA NR279, DAMBOVITA, ROMANIA
Address BANGALORE KARNATAKA
Phone +919900511990 +40727178003
I. 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.

Date :09/MAR/2023