ASSISTANT HIGH COMMISSION OF INDIA

KHULNA(BANGLADESH) Paste your unsigned

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Visa Application Form

Signature
BGDKV051F320

A. Personal Particulars (As in Passport)

Surname (As in Passport) AHMED
Given Nam e (As in Passport) SHAIKH MOHIUDDIN
Previous/other Name if any
Sex MALE Marital Status MARRIED
Date of birth 07-APR-1960 Religion ISLAM
KHULNA BANGLADESH
Application Id :BGDKV051F320

Place of Birth Town/City Country of Birth

Citizenship /National ID No 2800501252 Educational Qualification HIGHER SECONDARY
Visible identification marks NIL
Current Nationality BANGLADESH Nationality by Birth/ Naturalization BY BIRTH
Any Other Previous/Past Nationality
B. Passport Details
Passport No. EE0836948 Date of issue ( dd/mm/yyyy ) 23-JAN-2020
Place of issue DHAKA Date of expiry (dd/mm/yyyy) 22-JAN-2025
Any other Passport/Identity Certificate held (if yes ,please fill in the following) YES
Country of issue BANGLADESH Place of issue DHAKA
Passport/IC No BE0575346 Date of issue(dd/mm/yyyy) 16-FEB-2015
Web Registration Date : 01-MAR-2020

Nationality/status BANGLADESH
C. Applicant’s Contact Details

HOUSE-187, ROAD-9 Phone No 01714480386

Present
address SONADANGA R/A Mobile /Cell No 1714480386
KHULNA, BANGLADESH 9000 Email address

Permanent CHOTO BOYRA, MOSJID BARI ROAD

Address KHULNA GPO, SONADANGA
KHULNA

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
KHULNA
Father’s SHAIKH DEEN MOHAMMAD BANGLADESH BANGLADESH BANGLADESH
KHULNA
Mother’s HASINA BEGUM BANGLADESH BANGLADESH BANGLADESH
KHULNA
Spouse SOHANA AFSANA BANGLADESH BANGLADESH BANGLADESH
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) 12 Month Expected Date of Journey 30-MAR-2020
Port Of Arrival BY ROAD GHOJADANGA Port of Exit BY ROAD GHOJADANGA

SHAIKH MOHIUDDIN AHMED

 Required Detail of TOURIST VISA
Places to be Visited KOLKATA

Purpose of Visit : FOR RECREATION,SIGHT SEEING, CASUAL VISIT TO MEET FRIENDS OR RELATIVES, ATTENDING A SHORT TERM YOG
F. Previous Visit Details
Have You Ever visited India ? NO
Address where You stayed in
India
,

Application Id :BGDKV051F320
Cities in India Visited
Type of Visa Visa Number
Visa Issued Place Date of Issue
Countries visited in last 10 years
K.S.A
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 DEPENDENT Designation/Rank DEPENDENT
Employer name/business SHAIKH MOHIUDDIN AHMED
Employer Address HOUSE-187, ROAD-9, SONADANGA R/A, KHULNA
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.
1 SHAIKH BACHCHU 18, GRISH BIDYA RATNA LANE KOLKATA WEST BENGAL. 00918697293334,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India In BANGLADESH
Nam e SHAIKH BACHCHU SOHANA AFSANA
Address 18, GRISH BIDYA RATNA LANE CHOTO BOYRA, MOSJID BARI ROAD
KOLKATA-700009 SONADANGA, KHULNA
Phone
00918697293334 01714480386
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.

..……………………………………
01-MAR-2020
Date :………………………. Applicant’s signature (as in Passport)