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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