HIGH COMMISSION OF INDIA, DHAKA
VISA APPLICATION FORM (For Bangladesh Nationals only) Please note that furnishing false or misleading information will lead to refusal or cancellation of visa or penalties while in India.
FOR OFFICIAL USE ONLY
1. Purpose of Travel ____________________ 1.1 Please tick appropriately : TRANSIT TOURISM BUSINESS MEDICAL TREATMENT CONFERENCE VISIT RELATIVES OFFICIAL EDUCATION RESEARCH. TRAINING. If others, please specify: 1.2 Number of days for which visa is required: 1.3 Number of entries required : SINGLE DOUBLE MULTIPLE
Please paste one photograph here
2. Your Details: 2.1 SURNAME (AS IN PASSPORT)
FIRST NAME
MIDDLE NAME
2.2 Other name (e.g. name before marriage) 2.3 Father’s / Husband’s name 2.4 Date of birth 2.5 Place of birth 2.8 Passport Number 2.7 Sex : Male Female 2.10 Place of issue 2.11 Issuing Authority 2.13 Profession 2.14 Educational Qualifications: 2.15 Religion 2.16 Colour of eyes 2.19 Visible Distinguishing Marks 2.18 Nationality: Present Past 3. Your Contact Details: 3.1 Permanent address
2.6 Country of birth 2.9 Date of issue 2.12 Expiry date 2.17 Height Dual
3.2 Present home address
3.3 Present office name and address
3.4 Home telephone number/Mobile 4. Marital Status: Married 4.1 If married, spouse’s name 4.2 Nationality of spouse
3.5 Office telephone/fax number
3.6 Email address
Single 4.3 Date of Birth of spouse
5. Particulars of dependents included in your passport who are travelling with you Name Date of birth Place of Birth Relationship
Nationality
6. Do you hold any other valid passport? If yes, please give following details 6.1 Passport No. 6.2 Date of issue 6.3 Place of issue If Indian visa has been obtained on this passport, please give following details 6.4 Visa No 6.5 Date of issue 6.6 Place of issue
7. Details of present visit 7.1 Date of Arrival in India 7.2 Date of Departure from India 7.3 Checkpost/Airport of Entry 7.4 Checkpost/Airport of Exit 7.5 In case different checkposts are used for entry and exit, please give reasons:
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7.6 (a) Name, full address (with telephone number) and occupation of the person (s) to be visited
7.6 (b) Relationship with the applicant
7.7 (a) Name and full address of place of stay in India including Hotel(s)
7.7 (b) Telephone number 7.7 (c) Fax number 7.7 (d) E-mail address
Place Staple/ Pin one photograph
8. Details of last three visits to India on this or any other passport Visa No. No. of days Passport No. Date of Date of visa granted arrival in departure from India India
Reasons for extension, if any
9. Details of two persons each in India and in Bangladesh to whom reference may be made, if required: IN INDIA IN BANGLADESH 9.1 (a) Name: 9.3 (a) Name: 9.1 (b) Address: 9.3 (b) Address:
9.1 (c) Tel.No./Mobile No. 9.1 (d) E-Mail 9.2 (a) Name: 9.2 (b) Address:
9.3 (c) Tel.No./Mobile No. 9.3 (d) E-Mail 9.4 (a) Name: 9.4 (b) Address:
9.2 (c) Tel.No./Mobile No. 9.2 (d) E-Mail
9.4 (c) Tel.No./Mobile No. 9.4 (d) E-Mail
10. Previous Applications and travel 10.1 Have you had a visa for India cancelled? 10.2 Have you been refused a visa or entry clearance by an Indian Diplomatic Mission or Post? 10.3 Have you ever been refused permission to leave India? 10.4 Have you ever been refused a visa for another country? 10.5 Have you ever been deported, removed or otherwise required to leave India? 10.6 Have you ever been deported from any country? If the answer to any of the above questions is yes, please give details: 10.7 Visa number 10.8 Place of issue of visa 10.9 Date of Issue 10.10 Purpose for which applied 10.11 Please give details(e.g. deportation order, reference number, etc)
Yes Yes Yes Yes Yes Yes
No No No No No No
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11. Have you ever worked with ARMED FORCES / POLICE / PARAMILITARY FORCES? Yes No If yes, please complete the additional sheet available with the Visa Application Centre and submit with your application form. 12. To be answered by applicants visiting India for MEDICAL TREATMENT only: Please give following details: (Please ensure that all necessary documents as mentioned in the instructions at III.i are enclosed with the application) IN BANGLADESH IN INDIA 12.1 Name and complete address of the hospital/clinic in Bangladesh which referred you to India 12.4 Name and complete address of the hospital/clinic in India where you wish to undergo treatment
12.5 Name of doctor 12.2 Name of doctor 12.3 Tel.No./Fax No. E-Mail/website address 12.6 Tel.No./Fax No. E-Mail/website address
12.5 Describe the nature of illness and expected duration of treatment
13. To be answered by BUSINESS VISA APPLICANTS only: Please give details of the company in India: (Please ensure that all necessary documents as mentioned in the instructions at III.ii are enclosed with the application) 13.1 Name 13.3 Tel.No./Fax No. 13.2 Address: 13.4 E-Mail
13.5 Annual turnover of business with India in the past three years
14. To be answered by STUDENTS VISA APPLICANTS only: Please give details of the institution to which admitted (Please ensure that all necessary documents as mentioned in the instructions at III.iii are enclosed with the application) 14.1 Name of the institution 14.2 Address 14.3 Tel.No./Fax No. 14.4 E-Mail/website address
14.5 Describe the course you wish to follow (Please submit evidence of acceptance to the course and accommodation)
15. To be answered by TRANSIT VISA APPLICANTS only: Travelling to another country Name of the country (a) Before India (b) After India Yes Yes No No
Do you have a visa or a resident permit of that country Not required Yes No Not required Yes No
16. DECLARATION : i. I do not hold any other passport(s) other than those detailed above. ii. I have read and understood all the conditions for the visit to India and am willing and able to abide fully by them. iii. I declare that the information given in this form is complete and correct and the visit to India will be undertaken for the purpose indicated in the application. iv. I understand that in case the information provided in the form is found to be incorrect I will be liable for denial of visa/entry or deportation and other penalties during the visit as provided by Indian law.
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Date_________________
Applicant’s signature (as in passport) ___________
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