To: THE H.

E, HIGH COMMISSION OF INDIA, DHAKA, BANGLADESH

We request you to issue the medical visa (MV) for the patient.

1. Reference No: AHB/20231016-2274 Date of Issue: 16th October, 2023

2. Name and full address of Hospital in India Apollo Hospitals – Bannerghatta Road, Bangalore - India.
3. Name of the Patient Tahmida Sultana Sakia
4. Profession of the Patient NA
5. Passport No. A11256655
6. Name of Doctor/Hospital treating the NA
patient
7. Provisional diagnosis & Treating Doctor Patient needs to come for evaluation & work-up followed by
surgical/medical management.
Dr. Sumant Mantri, Senior Consultant – Pulmonology, Apollo
Hospital Bannerghatta Road, Bangalore. The appoinment is
scheduled on 15th December 2023 (Friday) at 09:00 AM.
8. Does the patient’s medical condition NO
require an attendant to accompany
him/her
9. Likely duration of treatment in India One Month
10. Sponsor Details:
a. Name of the Sponsor NA
b. Relationship with the patient NA
c. Sponsor Bank Account No. NA
d. Sponsor Bank Name & Branch NA
11. Name of the Attendant-1 NA
Passport No.
12. Relationship with Patient NA
13 Name of the Attendant 2 (if required) NA
Passport No.
14. Relationship with patient NA
15. Whether coming for follow-up NO
16. If yes, date/duration of last visit* NA NA
17. Authorized signatory Mithun Chakraborty Assistant Manager-International Patient
Services
18. Contact details of signatory +91-8892587637 mithun_chakraborty@apollohospitals.com
The Hospital will be responsible for the reception, immigration formalities and departure of the patient and attendant(s) on
conclusion of the medical treatment of the patient.