9/16/21, 10:26 PM Application Summary

VISAS/PRECLEARANCE IRELAND

FOR OFFICIAL USE ONLY

Application Reference / Transaction Number: 47584782

Type of Visa/Preclearance: Short Stay
Journey Type: Single Journey
Visa/Preclearance category: Visit Family/Friend
Surname: GOPAL
Forename: VIDYA
Other names:
Date of Birth: 12/06/1988
Gender: Female
Nationality: India
Passport / Travel Document Number: T5717494
Issue Date: 01/05/2019
Expiry Date: 30/04/2029
Dates of Travel From: 22/11/2021
Dates of Travel To: 18/02/2022

WARNING!

YOU HAVE NOT COMPLETED THE APPLICATION PROCESS YET

In order to complete the application process you must:

1. print and sign this summary application sheet

2. log on to the online payment and appointment booking website below to pay the visa application fee (if
applicable) and service charges AND book an appointment at a visa application centre (VAC) to have
your biometric information (fingerprints and live capture facial image) taken
3. attend for your appointment at the VAC and bring the signed summary application sheet and your
documents (see below) with you to your appointment

Your appointment at the VAC must take place within 30 days of completing your online application.

Payment/appointment booking website: http://www.vfsglobalirelandvisa.com/India

Documents you must bring with you to the VAC when you attend for your appointment

1. Printed and signed application summary sheet

2. Original passport
3. Passport sized colour photographs

https://www.visas.inis.gov.ie/AVATS/SummaryDetails.aspx 1/3
9/16/21, 10:26 PM Application Summary

4. Evidence of payment of the visa fee (unless you are fee exempt)
5. Supporting documents for the relevant visa category
6. All supporting documentation must be in English or accompanied by a notarised translation

Please see www.inis.gov.ie "Visas" for further information on the documents which you are required to bring
with you to the VAC

Application will be held online for 30 days

Please note that your application will be held online for 30 days. It can be retrieved and printed at any time
during this period. However, it will not be possible for you to make changes to any of the details that you have
provided.

DECLARATION BY APPLICANT

You must now read the declaration below and sign it. This must be signed by the applicant
personally.

An application for a person under the age of 18 should be completed by the parent or legal
guardian.

DECLARATION

I hereby apply for a visa/preclearance to travel to Ireland. The information I have given is complete and is true
to the best of my knowledge. I also declare that the photograph submitted with this form is a true likeness of
me, the applicant. I confirm that if, before the application is decided, there is a material change in my
circumstances or new information relevant to this application becomes available, I will inform the Embassy/
Consulate/Visa Office handling my application.

I understand that I may be required to provide my biometric information (fingerprints and facial image) before
my application will be processed and that any such information, together with my biographical information, will
be collected by the United Kingdom Home Office or another authorised agent on behalf of the Irish
Naturalisation and Immigration Service of the Department of Justice and Equality.

I understand that I may be recorded by electronic means (CCTV) when I attend at a centre for the purpose of
providing my biometrics and biographical details or lodging my documents and that any such recordings may
be retained for the purpose of maintaining the integrity of the visa/preclearance application process.

I understand that additional information may be required before my application can be processed. I understand
that failure to provide such data, if requested to do so by the Embassy/Consulate/ Visa Office, may result in the
refusal of my application.

I understand that any false or misleading information, or false supporting documentation, may result in the
refusal of my application and that this may result in me being prevented from making further Irish
visa/preclearance applications for a period of up to five years. An appeal, against the decision to refuse to grant
the visa/preclearance sought, may not be permitted.

I also understand that if I have incorrectly claimed to be exempt from the requirements to provide biometrics my
application may be refused and I may be prevented from making further Irish visa/preclearance applications for
a period of up to five years. An appeal, against the decision to refuse to grant the visa/preclearance sought,
may not be permitted.

I understand that the outcome of this visa/preclearance application may be made available to the United
Kingdom Home Office for the purpose of preserving the integrity of the Common Travel Area.

I understand that the application form and supporting documentation or copies thereof, may be conveyed to the
Irish deciding authority as considered appropriate by the receiving office, including commercial courier (in a
sealed package) or other postal or electronic means.

Signature of applicant / parent or legal guardian

(in case of an applicant under 18 years of age)

Date

https://www.visas.inis.gov.ie/AVATS/SummaryDetails.aspx 2/3
9/16/21, 10:26 PM Application Summary

https://www.visas.inis.gov.ie/AVATS/SummaryDetails.aspx 3/3