Visa Application Form

A. Personal Parti cul ars (As in Passport)

Surname (As in Passport)
Given Name (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 Detai l s
Passport No. Date of issue ( dd/mm/yyyy )
Place of issue Date of expiry (dd/mm/yyyy)
Any other Passport/Identi ty Certi fi cate hel d (i f yes ,pl ease fi ll i n the foll owing)
Country of issue Place of issue
Passport/IC No Date of issue(dd/mm/yyyy)
Nationality/status
C. Appl icant s Contact Detail s
Phone No
Mobile /Cell No

Present
address

Email address

Permanent
Address

D. Famil y Detail s

Rel ati on Name Nati onali ty Prev. Nat ional ity Pl ace/Country of Birth
Fathers
Mothers
Spouse
Were your Grandfather/Grandmother(Paternal/Maternal ) Paki stan Nati onals Or bel ong to Paki stan hel d area :
E. Detail s of Vi sa Sought (Visa shall be valid from the Date of Issue and not from the Date of J ourney)
Type Of Visa Required No of Entries
Period of Visa Expected Date of J ourney
Port Of Arrival Port of Exit


Paste your unsigned
recent color photograph.
Size: 2 X 2


Signature
LKAK01274614
NEELA PADMINI NISHSANKAGE
COLOMBO
SRI LANKA
SRI LANKA
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DEBATHGAMA
NEELA PADMINI
SRI LANKA
SRI LANKA
0771721324
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PRENSIS NAINANGKADA
04-APR-2014
04-APR-2016
amindadinu@yahoo.com
3 Month
NISHSANKAGE
Kandy
BY BIRTH
NO
ARANAYAKE
DEBATHGAMA
SRI LANKA
ALL PORT
ARANAYAKE
SRI LANKA
NAINAGKADA,
WATHURA.
SABARAGAMUWA
25-NOV-1963
SRI LANKA
31, Rajapihilla Mawatha
Double
N GUNADASA
Female
638301784V
SRI LANKA
EC6325473
Married
NO
0355686883
www.ahcikandy.org
NO
(Month)
E SISILIN ATUGALLA
Assitant High Commission of India
18-AUG-2014
TOURIST VISA
HIGHER SECONDARY
WATHURA.
BUDDHISM
NAINAGKADA,
SABARAGAMUWA, SRI LANKA 71500
0094812222652
Required Detail of

Purpose of Visit :
F. Previ ous Vi si t Detail s
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. Professi on/Occupati on Detail s
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. Detail s of Two Reference
In Indi a In
Name
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)
L L A D JAYASURIYA
NO
SRI LANKA
NO
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SELF EMPLOYMENT
HOUSE WIFE
48C, DEMALAHIRIYA,
21-JUL-2014
0771721324
FARMER
CHENNAI 600001.
NAINAGKADA, WATHURA.
NO 05, T V N STREET, PUDUPPET,
ARANAYAKE.
,
of Spouse
C RAJU
9840480845
Places to be Visited
0355686883
NO
TOURISM
CHENNAI, GAYA, VARANASI, DELHI
TOURIST VISA