Visa Form For Bangladeshi Nationals APPLICATION FORM FOR INDIAN VISA (OTHER THAN DIPLOMATlC/OFFlCIAL) 1. 2. 3. 4. 5. 6. 7.

Full name: Mr./Mrs./Miss (Block letters) Date & Place of Birth Religion Educational Qualifications Occupation Nationality Address (a) (b) (c) 8. 9. Permanent Present (if different from above) Telephone

Name address & Nationality of Father/Husband (i) Whether the following migrated to areas now constituting Bangladesh on or after 1 March 1947 (a) (b) (ii) if so (a) (b) Approximate date of migration Address in India before migration Applicant Applicant's father/husband

10.

Children accompanying the applicant, if any Sex Date & Place of Birth

Sr.No. Name 1) 2) 3) 4)

2 11. Particulars of Passport a) Number, date and place of issue b) Date of expiry c) If possible International Passport whether it has been endorsed Valid for India 12. Whether previously in India and if so, places of residence with date: 13. Whether permission to visit India or to extend stay in India has been refused previously, and, if so, when and by whom? 14. i) ii) Purpose for which visa required now and the period Proposed date of departure and return

15. If travelling by land route specify the Indian check post through which entry and exit desired 16. Places proposed to be visited with full address 17. Whether transit visa/short term single entry/long term multiple entry visa required

18 For Transit Visa OnIy i) ii) Country of final destination (a) (b) Is passport valid for that country Has visa/Immigration permit of that country been obtained?

For Students Only 19. Name and address of the institution in India in which admission has been secured (Attach attested copy of Admission Certificate or other relevant document)

20

Names and addresses of two persons in India and in Bangladesh to whom the applicant is well known:

3 In India 1 2 1. 2. In Bangladesh

21.

How expenses for stay in India are proposed to be met (state foreign exchange authorised) If not carrying foreign exchange, furnish sponsorship certificate in prescribed form; Return Air Ticket or onward journey ticket.

22.

I enclose copies of this application along with . copies of my recent photograph. I, hereby certify that the information furnished above is correct and further undertake that I shall utilise my visit to India for the purpose for which the visa has been applied for and shall not on arrival in India, try to obtain employment paid or unpaid or set up business or to extend my stay for any other purpose.

Signature Date:

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