EMBASSY
OF INDIA
______________________________
CONSULATE
GENERAL OF INDIA ______________________
HIGH
COMMISSION OF INDIA
________________________
Consular
Wing
VISA
APPLICATION FORM
For
Office use only
(Please
Type or Print)
(Please
read the instructions carefully before filling the application)
1.
Full Name :
........................................................................................................................
(First)
(Middle) (Last)
2.
Last
name at birth (if different) :
.........................................................................................
3.
Marital
Status : Married/Unmarried
....................................................................................
4.
If married
give maiden name :
............................................................................................
5.
Date of
Birth : ............. / ....................... /
........................... 6. Sex : Male/Female
mm dd yy
7.
Place of
birth (City, State & Country):
................................................................................
8.
Current
Nationality :
...........................................................................................................
9.
Are you a
permanent/log-term resident in this country? Yes . No. ..............
If yes,
please furnish photocopy of such document/GREEN-CARD/Long-Term Visa
status : ......
(For
Non-US passport holders only)
10.
Nationality at birth ................................... 11. Any other
nationality held at present :................
12.
Present Address :
.................................................................................................................
...........................................................................................................................................
13. Phone
:...........................................(Home)
.............................(Work ) ..............................
Paste your
PHOTO
here
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14.
Permanent Address :
............................................................................................................
...........................................................................................................................................
15.
Profession
...........................................................................................................................
16.
Employer's Name and Address :
............................................................................................
...........................................................................................................................................
17.
Passport Number : ..................................................... 18.
Valid Till.:.....................................
19. Issued
at : .................................................................. 20 .
Issue Date : ................................
21.
Father's/Husband's Name:
....................................................................................................
22.
Nationality of Father/Husband :
.............................................................................................
23. Name
and Nationality of Mother :
.........................................................................................
24. Type
of Visa required : ...... Tourist ...
Business ... Student ...Entry .... Transit ....Journalist.... Others ..
25. Period
of Visa : ............ 15 Days*
......... Six Months........... One Year ........... Five Year.........
(* For
Transit only)
26. Have
you ever visited India before ? If yes,
give address where you stayed with dates :
...........................................................................................................................................
27. Has
Indian visa or extension of the same
ever been refused to you previously? YES/NO: ...........
If yes,
give details :
...............................................................................................................
28. Are
you holding a valid "NO OBJECTION TO RETURN TO INDIA"
endorsement?
YES/ NO
:.................. . If yes, give details
........................................................................
...........................................................................................................................................
29. Object
of Journey :
.............................................................................................................
30. Are
you travelling on behalf of a company? YES / NO
31. If
yes, give name and address of company :
........................................................................
...........................................................................................................................................
32.
Expected date of departure :
................................................................................................
33.
Expected date of arrival in India
:...........................................................................................
34. Port
of arrival in India :
.................................................................................
35. Are
any children included in your passport accompanying you? YES/ NO. If yes,
give details :
Full Name
Date of Birth Sex
(a)
......................................................................................................................................
(b)
......................................................................................................................................
36. Name
and address of two references :
i) In India
...........................................................................................................................
...........................................................................................................................................
ii) In
applicants Country
.....................................................................................................
...........................................................................................................................................
I,
...............................................................................................
, hereby undertake that I shall
utilize 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 or
set up business or extend my stay for any other purpose.
Signature
of applicant : .............................................................
Date :
.................................. Place
...........................................
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