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Visa Application Form
A. Personal Particulars (As in Passport) Surname (As in Passport) Given Nam e (As in Passport) Previous/other Name if any Sex Marital Status Date of birth Religion Place of Birth Town/City Country of Birth Citizenship /National ID No Educational Qualification Visible identification marks Current Nationality Nationality by Birth/ Naturalization Any Other Previous/Past Nationality B. Passport Details Passport No. Date of issue ( dd/mm/yyyy ) Place of issue Date of expiry (dd/mm/yyyy)
Any other Passport/Identity Certificate held (if yes ,please fill in the following)
Country of issue Place of issue Passport/IC No Date of issue(dd/mm/yyyy) Nationality/status
C. Applicants Contact Details Phone No
Mobile /Cell No
Present address
Email address
Permanent Address
D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
Fathers
Mothers
Spouse
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : E. Details of Visa Sought (Visa shall be valid from the Date of Issue and not from the Date of Journey)
Type Of Visa Required No of Entries
Period of Visa Expected Date of Journey
Port Of Arrival Port of Exit
Paste your unsigned recent color photograph.
Size: 2 X 2
S ig nat ure
BGDDY6F40115
NAYEEM AFTAB
DHAKA
BANGLADESH
BANGLADESH
BANGLADESH
Appli
catio
n Id :
BGDD
Y6F4
0115
NILPHAMARI
NAYEEM
BANGLADESH
+8801717181032
Web
Reg
istra
tion D
ate : 0
1-DE
C-20
15
BY RAIL GEDE
05-NOV-201404-NOV-2019
3 Month
AFTAB
DHAKA(BANGLADESH)
BY BIRTH
N/A
NILPHAMARI
NILPHAMARI
BANGLADESH
BY RAIL GEDE
WARD-08UKIL PARANILPHAMARI
31-DEC-1989
BANGLADESH
Double
AFTAB UDDIN
Male
2694812094560
BANGLADESH
BC0525331
Single
NO
NO
(Month)
NAZNEEN HOSSAIN
HIGH COMMISSION OF INDIA
09-DEC-2015RESEARCH OR TRAINING VISA
BANGLADESH
GRADUATE
AHMED NAGOR, MIRPUR
ISLAM
367/4B
DHAKA, BANGLADESH 1216
Required Detail of
Purpose of Visit : F. Previous Visit Details Have You Ever visited India ? Address where You stayed in India
Cities in India Visited Type of Visa Visa Number
Visa Issued Place Date of Issue Countries visited in last 10 years
Have you been refused an Indian Visa or extension of the same previously or deported from India ? If yes above mention when and by whom with control No/Date
G. Profession/Occupation Details Present Occupation Designation/Rank
Employer name/business Employer Address
Phone Number
Past occupation if any Are/have you worked with Armed forces/ Police/ Para Military forces ? Organization Designation Place of Posting Rank H. Address of Place of Stay / Hotel Place/Hotel Name Address of Place / Hotel State Phone No.
I. Details of Two Reference In India In
Nam e Address
Phone Number
J. 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 :. Applicants signature (as in Passport)
4 . ,
RAFIQUL ISLAM
NO
BANGLADESH
3 . ,
CHINA
Appli
catio
n Id :
BGDD
Y6F4
0115
BANGLADESH INDUSTRIAL X-RAYPRIVATE SERVICE
367/4B, AHMED NAGOR, MIRPUR, DHAKA
2 . ,
01-DEC-2015
+8801781743183
NDT ENGINEER
1 DONA WORLD TECHNICAL TRAINING 130(76), KAMAL PARK, BIRATI, KOLKATA: 700 051 KOLKATA WEST BENGAL . +9103332562688, [email protected]
UN-EMPLOYED
HOUSE#10, ROAD# 2, SECTION# 11, MIRPUR, DHAKA
130(76), KAMAL PARK, BIRATI, KOLKAT
,
MOUMITA,DONA WORLD TECHNICAL TRAINING INSTITUTE
+9103332562688
EmailDuration
AddressPhone
Institution
+8801963622600
NO
OTHERS
DONA WORLD TECHNICAL TRAINING INSTITUTE130(76), KAMAL PARK, BIRATI, KOLKATA: 700 [email protected] MONTH
CSWIP
RESEARCH OR TRAINING VISA