HCI COLOMBO

36-38 GALLE ROAD, P O BOX NO 882 Paste your unsigned

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COLOMBO 3, SRI LANKA Size: 2" X 2"
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Visa Application Form

Signature

LKAC02133824

A. Personal Particulars (As in Passport)

Surname (As in Passport) NAVANESAN
Application Id : LKAC02133824

Given Name (As in Passport) GOBIDAN

Previous/other Name if any Not Applicable
Gender MALE Marital Status MARRIED
Date of Birth 05-NOV-1990 Religion HINDU
Place of Birth Town/City MOOLAI Country of Birth SRI LANKA
Citizenship /National ID No 903102420V Educational Qualification GRADUATE
Visible identification marks NA
Current Nationality Nationality by Birth/
SRI LANKA Naturalization BY BIRTH
Any Other Previous/Past Nationality Not Applicable
B. Passport Details
Passport No. N9257326 Date of Issue ( dd/mm/yyyy ) 07-JAN-2022
Place of Issue COLOMBO Date of Expiry ( dd/mm/yyyy ) 07-JAN-2032
Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Country of Issue Place of Issue
Web Registration Date : 07-MAR-2024

Passport/IC No. Date of issue (dd/mm/yyyy)

Nationality/Status
C. Applicant's Contact Details
3/1, CROWN COURTS, MOORS
Present ROAD, Phone No 0719423846
Address COLOMBO 06 Mobile /Cell No
WESTERN, SRI LANKA 006000 Email address GOBI1105@GMAIL.COM

Permanent AZ, 2ND LANE, HOUSING SCHEME,

Address OMANTHAI
NORTHERN

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
MOOLAI
Father's NAVANESAN SRI LANKA SRI LANKA SRI LANKA
JAFFNA
Mother's MITHILADEVI SRI LANKA SRI LANKA SRI LANKA
POINT PETRO
Spouse THENUKA SIVASUNDARAM SRI LANKA SRI LANKA SRI LANKA
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO

GOBIDAN NAVANESAN
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 SINGLE
Period of Visa ( Month) 3 Month Expected Date of Journey 21-APR-2024
Port Of Arrival HYDERABAD Port of Exit NEW DELHI
Required Detail of TOURIST VISA
Places to be Visited HYDERABAD, NEW DELHI,
SRINAGAR
Purpose of Visit : TOURISM,RECREATION,SIGHT-SEEING
F. Previous Visit Details
Have You Ever visited India ? YES
Address where You stayed in 250-A, ROAD NO-06, BLOCK RZ,
India MAHIPALPUR VILLAGE, , NEW DELHI
Cities in India Visited DELHI, HARIDWAR, KULLU, MANALI
Type of Visa TOURIST VISA Visa Number VJ9628133
Visa Issued Place SRILANKA Date of Issue 23-MAR-2017
Countries visited in last 10 years INDIA, THAILAND, SINGAPORE, MALAYSIA
Have you been refused an Indian Visa or extension of the same previously or deported from India ? NO
G. Profession/Occupation Details :

Application Id : LKAC02133824
Present Occupation ENGINEER Designation/Rank CAD ENGINEER
Employer name/business RESOURCES DEVELOPMENT CONSULTANTS PVT LTD
Employer Address
Phone Number 52, GALLE ROAD, COLOMBO 03
Past occupation if any ENGINEER
Are/have you worked with Armed forces/ Police/ Para Military forces ? NO
Organization Designation
Place of Posting Rank
H. Details of Two Reference
In India In SRI LANKA
Name SUBHASH RANA NAVANESAN
PLOT NO:8-2- 293/82/J/B/49/1,
Address ROAD NO 3, AZ. 2ND LANE, HOUSING SCHEME,
FILM NAGAR, JUBILEE HILLS,
HYDERABAD HYDERABAD
TELANGANA OMANTHAI
Phone Number 00914023331237 0094776156075
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.
e. I will also submit hard-copy all the uploaded documents along with the print of application to submit to the concerning Indian Mission or
Agency for processing of visa application.

07-MAR-2024 ................................
Date : ...................... Applicant's signature (as in Passport)