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VISA APPLICATION FORM FOR KINGDOM OF BHUTAN

(Please fill in block capital


1.
Name in Full: ________________________________________________________
(Surname)

2.

Date of Birth: ____________________________


(Day)

Male

(Month)

Female

(Year)

3.

Sex :

Marital Status:

Married

Single

4.

Nationality : ____________________________________________

5.

Passport No: _______________________ Place of issue: ____________________

Attach passport
size Photograph
(3.5 x 4.5 cm)

Date of Issue: ___________________ Valid until: ________________________


(DD MMYYYY)

(DD MMYYYY)

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 ______________________


(DDMMYYYY)

(DDMMYYYY)

10.

Port of entry/exit into Bhutan: Entry Port____________________ Exit Port ______________________

11.

Purpose of visit to Bhutan:________________________________________________________ _____

12.

Is this your first visit to Bhutan?

Yes

No

If No, give details of earlier visit

____________________________________________________________________________________
____________________________________________________________________________________
I hereby declare that the statement given above is true and correct. I fully understand not to indulge in any
activity which, are inconsistent with the purpose for which I have stated above. I understand that the period of
stay to be granted is decided by the Bhutanese Immigration Authorities upon my arrival.

Date : __________________
Place: _________________

Signature of Applicant ________________

For Official use only


Type of Visa

:____________________________

Visa Number

:____________________________

Date of Issue

: ___________________________

Visa Clearance No. : ___________________________

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