High Commission of India

Menara 1 Mont Kiara, Level 28,

50480 Kuala Lumpur Paste your unsigned
www.indianhighcommission.com.my recent color photograph.
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Visa Application Form

Signature
MYSK11093917

A. Personal Particulars (As in Passport)

Surname (As in Passport) BIN SEENI ABDUL WAHID
Given Nam e (As in Passport) SHEIK HANIF SHAH
Previous/other Name if any
Sex MALE Marital Status SINGLE
Date of birth 05-AUG-1997 Religion ISLAM
WP KUALA LUMPUR MALAYSIA
Application Id :MYSK11093917

Place of Birth Town/City Country of Birth

Citizenship /National ID No 970805565007 Educational Qualification HIGHER SECONDARY
Visible identification marks NIL
Current Nationality MALAYSIA Nationality by Birth/ Naturalization BY BIRTH
Any Other Previous/Past Nationality
B. Passport Details
Passport No. A40587348 Date of issue ( dd/mm/yyyy ) 17-JUL-2017
Place of issue MINI UTC KERAMAT Date of expiry (dd/mm/yyyy) 17-JUL-2022
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 : 19-JUL-2017

Nationality/status
C. Applicants Contact Details

NO 48 JALAN BEE ENG 3 Phone No 011-23745482

Present
address TAMAN TAYTON VIEW CHERAS Mobile /Cell No

KUALA LUMPUR, MALAYSIA 58000 Email address

Permanent NO 48 JALAN BEE ENG 3

Address TAMAN TAYTON VIEW CHERAS
KUALA LUMPUR

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
INDIA
Fathers SEENI ABDUL WAHID MALAYSIA INDIA
INDIA
Mothers TAUSELA BANU INDIA INDIA

Spouse

Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO

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 TOURIST VISA No of Entries MULTIPLE

Period of Visa ( Month) 6 Month Expected Date of Journey 06-AUG-2017
Port Of Arrival TRICHY Port of Exit

SHEIK HANIF SHAH BIN SEENI ABDUL WAHID

 Required Detail of TOURIST VISA
Places to be Visited TRICHY

Purpose of Visit : INDIVIDUAL TOURIST

F. Previous Visit Details
Have You Ever visited India ? NO
Address where You stayed in
India
,

Application Id :MYSK11093917
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 UN-EMPLOYED Designation/Rank
Employer name/business NIL
Employer Address NIL
Phone Number
Past occupation if any
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.

I. Details of Two Reference

In India In MALAYSIA
Nam e MS MAIMUNNA GS TRAVEL
Address NO 6 25 MUSLIM STREET NO 61 2ND FLOOR MEDAN BUNUS
REGUNATHAPURAM 623707 RAMNAD T.NADU JALAN MASJID INDIA 50100 K.LUMPUR
Phone
00919489356513 0326923271
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.

..
19-JUL-2017
Date :. Applicants signature (as in Passport)