ASSISTANT HIGH COMMISSION OF INDIA

KHULNA(BANGLADESH) Paste your unsigned

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Size: 2” X 2”

Visa Application Form

Signature
BGDKV0521020

A. Personal Particulars (As in Passport)

Surname (As in Passport) AHMED
Given Nam e (As in Passport) MOHINE
Previous/other Name if any
Sex FEMALE Marital Status SINGLE
Date of birth 15-NOV-1998 Religion ISLAM
KHULNA BANGLADESH
Application Id :BGDKV0521020

Place of Birth Town/City Country of Birth

Citizenship /National ID No 1956260135 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. BY0168658 Date of issue ( dd/mm/yyyy ) 09-DEC-2018
Place of issue DHAKA Date of expiry (dd/mm/yyyy) 08-DEC-2023
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 : 01-MAR-2020

Nationality/status
C. Applicant’s Contact Details

187, SONADANGA R/A ROAD NO 09, 1ST Phone No 01714480386

Present
address PHASE, KHULNA SADAR, KHULNA SADAR Mobile /Cell No 1714480386
KHULNA, BANGLADESH 9100 Email address

Permanent 187, SONADANGA R/A ROAD NO 09, 1ST

Address PHASE, KHULNA SADAR, KHULNA SADAR
KHULNA

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
KHULNA
Father’s SHAIKH MOHIUDDIN AHMED BANGLADESH BANGLADESH BANGLADESH
KHULNA
Mother’s SOHANA AFSANA BANGLADESH BANGLADESH BANGLADESH

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) 12 Month Expected Date of Journey 30-MAR-2020
Port Of Arrival BY ROAD GHOJADANGA Port of Exit BY ROAD GHOJADANGA

MOHINE 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 ? YES
Address where You stayed in SHAIKH BACHCHU
India
18, GRISH BIDYA RATNA LANE, KOLKATA-700009

Application Id :BGDKV0521020
Cities in India Visited KOLKATA
Type of Visa TOURIST VISA Visa Number VL1392618
Visa Issued Place DHAKA Date of Issue 24-DEC-2018
Countries visited in last 10 years
INDIA
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 of Father
Present Occupation STUDENT Designation/Rank STUDENT
Employer name/business AZAM KHAN GOVT COMMERCE COLLEGE
Employer Address BABU KHAN ROAD, KHULNA-9100
Phone Number
+88041-722882
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 SHAIKH MOHIUDDIN AHMED
Address 18, GRISH BIDYA RATNA LANE 187, SONADANGA R/A, ROAD NO 09
KOLKATA-700009 KHULNA SADAR, 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)