VISA APPLICATION FORM FOR THE KINGDOM OF BHUTAN

(Please fill in block capital)

1. Name in Full: _______________________________________________________ (Surname)

2. Date of Birth: _________/_____________/________________(DD-MM-YYYY)

3. Sex: Male Female Marital Status: Married Single

4. Nationality: .________________________________________________________________________

5. Passport No: ___________________________ Place of issue: ________________________________

Date of Issue: ___________________________Valid until: ___________________________________ (DD– MM–YYYY) (DD– MM–YYYY)

6. Nature of Passport: Diplomatic Official Ordinary UN Laissez Passer

7. Permanent Address: __________________________________________________________________

Tel No.________________________

8. Occupation/Profession: ________________________________________________________________

9. Period for which visa is required: from ______________________________to ___________________ (DD– MM–YYYY) (DD– MM–YYYY)

10. Port of entry/exit: Entry Port ______________________ Exit Port _______________________________

11. Purpose of visit to Bhutan: _____________________________________________________________

12. Are you accompanying your spouse/parents/children? Yes No

If Yes, name of the spouse/parents/children ________________________________________________

13. Is this your first visit to Bhutan? Yes No

If No, give details of earlier visit(s) __________________________________________________

__________________________________________________________________________________

I hereby declare that the statement given above is true and correct. I am aware that the Bhutanese immigration

laws do not permit me to indulge in any activity other than the one stated above. I fully understand that

providing false information to the Immigration Authorities or indulging in other activities would result in

cancellation of my visa and deportation thereof.

Date: _____________________________

Place: _____________________________ Signature of Applicant: _________________

For Official use only

Approved/Not Approved/Others _________________________________

Signature of the Approving Officer _______________________________

Passport size Photo