Annexure I

FOR FOREIGN NATIONALS

PERSONAL PARATICULARS OF APPLICANT

(To be submitted in six copies)

1 (a) NAME : AKASH GUPTA NATIONALITY : Indian

(b) PLACE OF BIRTH : BOKARO STEEL

CITY, JHARKHAND

2 DATE OF BIRTH : 24-11-2000

3 FATHER NAME : ASHOK KUMAR GUPTA

4 a) PRESENT FULL ADDRESS: PERMANENT ADDRESS:

(IN INDIA)

CITY : Bokaro CITY : Bokaro

STATE : JHARKHAND STATE : JHARKHAND

5 a) PASSPORT NO : DATE : VALID UPTO :

B) VISA NO. : DATE : VALID UPTO :

6 PURPOSE & PERIOD OF STAY IN INDIA: :

Along with Full Address :

7 a) DO YOU BELONG TO DEFENCE FORCES : OF YOUR COUNTRY? :

8 ANY OTHER INFORMATION :

I hereby solemnly declare that the foregoing facts are true and correct and nothing is false therein and nothing material
has been concealed there from. I also agree that in case any information given by me is found false at a later, the certificate and
licence to operate, if granted, will be cancelled.

Name & Signature of Applicant

Place :

Dated :

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