Indian bangladeshi mdoesl by maidul99

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                                                                             Visa Application Form


                                                                                                                           Signature
                                                BGDD11025612

                                          A. Personal Particulars (As in Passport)




                                                                                                                                                                           Appointment Date : 28-FEB-2012 At : 8.30
                                          Surname                      SWAPNA BHATTACHARJEE
                                          Name                         SWAPNA BHATTACHARJEE
                                          Previous/other Name if any
                                          Sex                             Female                     Marital Status                       Married
Web File Number :BGDD11025612




                                          Date of birth                   05-JAN-1964                Religion                             HINDU
                                          Place of Birth Town/City        COMILLA                    Country of Birth                     BANGLADESH
                                          Citizenship /National ID No     1327603003617              Educational Qualification            HIGHER SECONDARY
                                          Visible identification marks    N/A
                                          Current Nationality             BANGLADESH                 Nationality by Birth/ Naturalization     BY BIRTH
                                          Any Other Previous/Past Nationality
                                          B. Passport Details
                                          Passport No.                   U0763605                    Date of issue ( dd/mm/yyyy )            24-FEB-2004
                                          Place of issue                 BARISAL                     Date of expiry (dd/mm/yyyy)             23-FEB-2014
                                          Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
                                          Country of issue                                           Place of issue
                                          Passport/IC No                                             Date of issue(dd/mm/yyyy)
    Web Registration Date : 17-FEB-2012




                                          Nationality/status
                                          C. Applicant’s Contact Details

                                          Present
                                                          MATLAB BAZAR P.S:MATLAB P.O: MATLAB                                Phone No

                                          address         MATLAB KALI BARI                                                            01925566313
                                                                                                                        Mobile /Cell No

                                                          CHANDPUR, BANGLADESH 3640                                     Email address ssbd2010@yahoo.com

                                          Permanent MATLAB BAZAR P.S:MATLAB P.O: MATLAB
                                          Address
                                                    MATLAB KALI BARI
                                                    CHANDPUR

                                          D. Family Details
                                          Relation        Name                                         Nationality            Prev. Nationality   Place/Country of Birth
                                                                                                                                                  COMILLA
                                          Father’s    SUDHIR BHATTACHARJEE                            BANGLADESH              BANGLADESH          BANGLADESH
                                                                                                                                                  COMILLA
                                          Mother’s    KANAN BALA DEBI                                 BANGLADESH              BANGLADESH          BANGLADESH
                                                                                                                                                  CHANDPUR
                                          Spouse      BABUL BHATACHARJEE                              BANGLADESH              BANGLADESH          BANGLADESH
                                          Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO
                                          E. Details of Visa Sought

                                          Type Of Visa Required     TOURIST VISA                                        No of Entries     Single
                                          Period of Visa    (Month) 1 Month                             Expected Date of Journey          01-MAR-2012
                                          Port Of Arrival           BY AIR/ HARIDASPUR                                   Port of Exit     BY AIR/ HARIDASPUR

                                                                     SWAPNA BHATTACHARJEE SWAPNA BHATTACHARJEE
 Required Detail of        TOURIST VISA
Places to be Visited           KOLKATA




 Purpose of Visit : TOURISM
 F. Previous Visit Details
 Have You Ever visited India ?        YES
 Address where You stayed in          BARASHAT, KOLKATA




                                                                                                                                                  Web File Number :BGDD11025612
 India
                                      ,
         Cities in India Visited WEST BENGAL,KOLKATA.
                   Type of Visa TOURIST VISA                Visa Number                        AP0993491
             Visa Issued Place DHAKA                        Date of Issue                      18-NOV-2010
Countries visited in last 10 years
ONLY INDIA.
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 of Spouse
        Present Occupation HOUSE WIFE                       Designation/Rank                       WONER
   Employer name/business RUMPOM ELECTRONIC
         Employer Address MATLAB BAZAR,CHANDPUR,BANGLADESH
             Phone Number
                                   01925566313
       Past occupation if any HOUSE WIFE
 Are/have you worked with Armed forces/ Police/ Para Military forces ? NO
 Organization                                                           Designation
 Place of Posting                                                         Rank
 H. Address of Place of Stay / Hotel
 Place/Hotel Name       Address of Place / Hotel                                                        State            Phone No.
1 BARASHAT BARASHAT,KOLKATA KOLKATA WEST BENGAL . 00913325139659,
2 .,
3 .,
4 .,
 I. Details of Two Reference
                         In India                                                          In   BANGLADESH
           Nam e SAMBO CHAKRABORTY                   SWAPAN CHAKRABORTY
        Address BARASHAT,KOLKATA                      GULSHAN,DHAKA

           Phone
                 00913325139659                                     01713114411
          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.




                                                                                          ..……………………………………
      17-FEB-2012
Date :……………………….                                                                        Applicant’s signature (as in Passport)

								
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