APPLICATION FORM

( Registration )

290819TAQ011

Application ID No. 290819TAQ011 Final Submission Date Thu Aug 29 20:12:09 IST 2019

FOR OFFICE USE ONLY

Reg. No. S 0 3 7 S D N 2 0 2 0

Personal Details
Surname
Given Name MOHAMMED ABDEEN ALI ELTAYEB Paste your
Sex Male Date of Birth 26/01/2000 Height (in cm) 0 Recent passport size
Age as on today Year(s) 19 Month(s) 11 Day(s) 28 photograph here
Place of Birth SHARQ ALNEEL,SHARQ ALNEEL,SUDAN
Father's Name ABDEEN
Mother's Name
Spouse's Name
Religion ISLAM Any Identification mark(s) preferably NO
visible

Present nationality SUDAN Previous nationality SUDAN

Manner of acquiring present nationality Birth
Date of acquiring present nationality
Whether holding dual NO
nationality? If yes, Name of the country of second nationality
provide the following:- Passport No. of second country
Date of Issue
Date of Expiry
Whether travelled on this passport earlier to
India

Whether person of Indian Origin NO

Address of last residence (Outside India)

Address BAHRI
City BAHRI Country SUDAN

Address intended for longer stay in India (Registration)

Address FL. NO. 303 JAMEER APPARTMENT SN-38/3/5/2 3/2, KONDHWA KHURD, PUNE-411048
City/ District PUNE State MAHARASHTRA
Pin Code 411048
Phone Number Mobile Number 9156380354
Any Other Address in India
Address
City/ District State
Pin Code
Phone Number Mobile Number
Email/Occupation/Profession Details
E-Mail Id abdeenmuhamad@gmail.com
Profession/Occupation STUDENT

Passport Details
Passport Number P05126669 Place of Issue SUDAN, BAHRI
Date of Issue 30/09/2018 Expiry Date 29/09/2023

Visa Details
Visa Number VL4175280 Place of Issue SUDAN, BAHRI
Date of Issue 24/07/2019 Expiry Date 23/01/2020
Valid For Double Entry Visa Type STUDENT VISA
Special endorsement, if any

Organization/Company/Institute/Hospital Details
Name SINHGAD COLLEGE
Address SN-40/4A/4B/1, NR- PMC OCTROI POST, KONDHWA SASWAD ROAD, KONDHWA BK, PUNE- 411048

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 290819TAQ011
Application ID No. 290819TAQ011

State MAHARASHTRA City PUNE

Telephone Number Email ID
Employer EPFO ID Establishment ID
Arrival Details
Place of embarkation/boarding for India KHARTOUM,KHARTOUM,SUDAN
Date of arrival in India 15/08/2019
Place of disembarkation/arrival in India MUMBAI AIRPORT
Mode of Journey Air Flight/ Ship/ Bus/ Train No.
Purpose of visit to India Studies

Previous Registration Details in India

Registration Number Place of Registration Visa Type Duration From To
Details of family members/attendant/dependents, if any accompanying.
Name Nationality Passport Number Relationship
Person to be contacted in Case of Emergency
Name Relationship
Address City
Country Phone Number
Category Others

Military service details

Organisation Designation
Rank Place of Last Posting
Country of Last Posting

Signature of the Applicant

Date_ _ _ _ _ _ _ _ _ _ _ _ _

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 290819TAQ011
Application ID No. 290819TAQ011

List of mandatory and non mandatory documents

Mandatory Documents.
1. Residence proof : Residence proof i.e. updated form 'C' generated by hotel/ lodge or Registered / Notarized Lease Deed or Utility Bill copy along with copy of photo-ID of landlord with
declaration.

2. Photo : Applicant's Photo

3. Visa : Copy of latest Indian visa
4. Passport : Bio-data page of passport

Registration office address

Office Name : FRO PUNE CITY

Address : Police Commissioner Office, Sadhu Waswani Road, Pune-1
City/District : PUNE
State : MAHARASHTRA
Pin Code : 0
Phone Number : 02026128977

Office opening time: 10.00 closing time: 13.00

There is no need to submit hard copy to concerned

FRRO/FRO

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