Please staple one

passport size
photograph taken
within the last six
months

Please paste one

passport size
photograph taken
within the last six
months

DEPUTY HIGH COMMISSION FOR THE PEOPLE'S

REPUBLIC OF BANGLADESH
9 Bangabandhu Sheikh Mujib Sarani, Kolkata-700017, WB, India

www.bdhckolkata.org

BANGLADESH VISA APPLICATION FORM

01. FULL NAME (as in passport): __________________________________________________________________________________

02. DATE OF BIRTH: ______________, 03. PLACE OF BIRTH (City/District): _____________State: ___________Country:__________
(dd/mm/yyyy)

04. SEX:

07.

Male

Female

05. NATIONALITY: ______________________ 06. RELIGION: _________________________

PASSPORT(S) DETAILS

NUMBER

PLACE OF ISSUE

DATE OF ISSUE

DATE OF EXPIRY

PRESENT PASSPORT
PREVIOUS PASSPORT (if any)*
* Need to submit old passport(s).
08. CONTACT NUMBERS:
(a) Phone (Res)__________________________(b) Cell__________________________ (c) E-mail__________________________
09. EDUCATIONAL QUALIFICATION: ___________________ 10. MARITAL STATUS:
11.

FAMILY DETAILS

Name

Single

Married

Divorced

Nationality

Widowed

Profession

Father
Mother
Spouse
(if married)
12. PRESENT ADDRESS:________________________________________________________________________________________
________________________________________________________________Phone:_____________________________________
13. PERMANENT ADDRESS (Full Postal Address)_____________________________________________________________________
________________________________________________________________Phone:_____________________________________
14. PRESENT PROFESSION (document to be attached): _______________________________________________________________
(a)

Name of the Office/Company/Organization/Business Firm/Institution: ________________________________________________

(b)

Address:___________________________________________________________Phone:_______________________________

Fax:________________________ Website:__________________________(c) Designation:_____________________________

15. PAST PROFESSION:___________________________Adress:___________________________ ____________________________

16. DETAILS ADDRESS WHERE YOU WILL STAY IN BANGLADESH DURING VISIT:
Care of:. ......

AddressPolice Station

DistrictTelephone..........Cell..

17. PURPOSE OF VISIT:

Tourism

Transit

Seminar/Conference/Workshop

Employment in Pvt. Organizations

Business

Official (Govt./Diplomatic)

Employment in UN/Intl Organizations

Investment

Cultural/Scientific Programme

Experts(s)/ Workers(s)/ Teacher(s)/ Representative(s) in Industrial/Educational/ Training / Artistic Activities etc.

Govt. Contractual Employment

Sports

Journalist/Media (Print & Electronic)

NGO Works

Missionary

Study

Research

Tablig

Others (Specify)............................................................................................

[Note: Please attach proof of proper documents based on your purpose of visit]

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18. FOR BUSINESS PURPOSE:

Name of the Company in Bangladesh:.
Address.....Phone.
19. FOR EMPLOYMENT PURPOSE:
(a) Name of the Company in Bangladesh where to be appointed:......
(i) Address:(ii) Phone:..
(iii) Fax..(iv) Website..... (b) Professional qualification:....................
(c) Designation/post to be employed: ..(d) Monthly total remuneration:
(e) PREVIOUS EXPERIENCE:
(i) Name of the Company/Organization:
(ii) Designation:.... (iii) Monthly total remuneration:
(iv) Service length: From..to.. (v) Reason of release:

20. NUMBER OF ENTRY(S) (Tick Appropriate Box)

Single Entry

Double/Triple Entries

..........Entries

21. EXPECTED DATE OF ENTRY IN BANGLADESH:_____________22. INTENDED DURATION OF STAY:

(dd/mm/yyyy)

Multiple Entries
(days)

23. PORT OF ENTRY / EXIT_____________________________/__________________________ (Please mention specific entry/exit port)

24. HAVE YOU EVER BEEN TO BANGLADESH?
Purpose of visit

Visa Number

Yes
Place of Issue

No

If yes, details of last visit.

Date of Issue

Date of Entry in
Bangladesh

Date of Exit from

Bangladesh

25. REFERENCE (Person whom may be contacted, if necessary)

IN INDIA OR HOME COUNTRY

IN BANGLADESH

NAME..

NAME

ADRRESS..

ADRRESS.

PHONE

PHONE

26. NAME AND RELATIONSHIP OF PERSON(S) TRAVELLING WITH YOU________________________________________________

27. DECLARATION: I declare that the information given in this application is correct to the best of my knowledge and belief. I am

fully aware that by making a statement, which is not true, I will render myself liable to prosecution under the law.

Date....................................................

Signature of Applicant (AS IN PASSPORT).............................................................

Place...................................................

Name............................................................................................................................

N.B. Please complete all columns or write "N/A" (Not Applicable) if needed, please write or type or print clearly.
Incomplete form will not be processed and the Mission will not be held responsible for such application.

FOR OFFICIAL USE ONLY

DO NOT WRITE IN THIS SPACE

Visa No Type of visa:.

Number of entry(s): Single/ Double/Triple/.........Entries/Multiple
Date of Issue:Validity:.
Authorized duration of stay:...
Remarks:......
(Name and designation of the issuing authority with seal)
Checked & Written by:.....................................................................................................................................

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