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

nayeem696@gmail.com

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, kkbhowmick@donaworld.com

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: 700 051+9103332562688KKBHOWMICK@DONAWORLD.COM1 MONTH

CSWIP

RESEARCH OR TRAINING VISA