( This form may be freely photocopied )

TO BE FILLED IN DUPLICATE

EMBASSY OF INDIA TWO

2536 MASSACHUSETTS AVE NW, WASHINGTON, DC-20008 PHOTOGRAPHS
TEL: (202) 939-9806 FAX: (202) 797-4693 REQUIRED
(ONE ON EACH
WEBSITE: www.indianembassy.org
APPLICATION
VISA APPLICATION FORM FOR BANGLADESHI NATIONALS FORM)

1. NAME IN FULL (BLOCK LETTERS ): MR./MRS./MISS._____________________________________________________

2. DATE OF BIRTH (DATE /MONTH? YEAR):_______________________________________________________________
3. PLACE OF BIRTH (CITY/PROVINCE/COUNTRY:_________________________________________________________
4. EDUCATIONAL QUALIFICATIONS:_____________________________________________________________________
5. NATIONALITY:________________________________________________________________________________________

6. ADDRESS:
(a) PERMANENT:____________________________________________________________________________________
(b) PRESENT:________________________________________________________________________________________
(c) TELEPHONE:_____________________________________________________________________________________

7. NAME, ADDRESS AND NATIONALITY OF FATHER/HUSBAND:____________________________________________

______________________________________________________________________________________________________

8. (i) WHEATHER FOLLOWING MIGRATED TO AREAS NOW CONSTITUTING BANGLADESH ON OR AFTER

01 / 03 / 1947. (1st March 1947)

(a) APPLICANT:_____________________________________________________________________________________
(b) APPLICANT ‘S FATHER /HUSBAND:_______________________________________________________________

(ii) IF SO,

(a) APPROXIMATE DATE OF MIGRATION:____________________________________________________________

(b) ADDRESS IN INDIA BEFORE MIGRATION:_________________________________________________________
__________________________________________________________________________________________________

9. CHILDREN ACCOMPANYING THE APPLICANT,IF ANY:

______________________________________________________________________________________________________
S. NOS. NAME SEX DATE & PLACE OF BIRTH
______________________________________________________________________________________________________

1.
2.
3.
4.
_______________________________________________________________________________________________________

10. PARTICULARS OF PASSPORT:-

(a) NUMBER ,DATE & PLACE OF ISSUE:________________________________________________________________
(b) DATE OF EXPIRITY:________________________________________________________________________________
(c) IF POSSESSING INTERNATIONAL PASSPORT, WHEATHER IT HAS BEEN ENDORSED VALID FOR
INDIA:_____________________________________________________________________________________________

11. WHETHER PREVIOUSLY IN INDIA AND IF SO, PLACES OF RESIDENCE WITH DATE:
DATE OF VISIT:__________________________________________________________________________________________
ADDRESS:_______________________________________________________________________________________________
12. WHETHER PERMISSION TO VISIT INDIA OR TO EXTEND STAY IN INDIA HAS BEEN REFUSED
PREVIOUSLY, AND IF SO, WHEN AND BY
WHOM:___________________________________________________________________________________________________
___________________________________________________________________________________________________
13. (i) PURPOSE FOR WHICH VISA REQUIRED
NOW:_____________________________________________________________________________________________________
(ii) PERIOD FOR WHICH VISA REQUIRED:_________________________________________________________________
(iii) PROPOSED DATE OF DEPARTURE:____________________________________________________________________
(iv) PROPOSED DATE RETURN:____________________________________________________________________________
14. IF TRAVELING BY LAND ROUTE, SPECIFY THE INDIAN CHECK POST THROUGH
WHICH ENTRY AND EXIT DESIRED:______________________________________________________________________
15. PLACES PROPOSED TO BE VISITED WITH FULL ADDRESS:
PLACES__________________________________________________________________________________________
ADDRESS IN FULL________________________________________________________________________________
16. WHETHER TRANSIT VISA/SHORT-TERM SINGLE ENTRY/LONG-TERM MULTIPLE ENTRY VISA
REQUIRED:__________________________________________________ ____________________________________________
17. FOR TRANSIT VISA ONLY:
(i) COUNTRY OF FINAL DESTINATION:____________________________________________________________________
(ii) (a) IS PASSPORT VALID FOR THAT COUNTRY:__________________________________________________________
(b) HAS VISA/IMMIGRATION PERMIT OF THAT COUNTRY BEEN OBTAINED:_____________________________

( FOR STUDENTS ONLY )

18. NAME AND ADDRESS OF THE INSTITUTION IN INDIA IN WHICH ADMISSION HAS BEEN SECURED
(ATTACH ATTESTED COPY OF ADMISSION CERTIFICATE OR OTHER RELEVANT DOCUMENT):
___________________________________________________________________________________________________________
_________________________________________________________________________________________________________

19. NAMES AND ADDRESS OF TWO PERSONS IN INDIA AND IN BANGLADESH TO WHOM APPLICANT IS
WELL KNOWN:
IN INDIA:

1.________________________________________________________________________________________________________
2.________________________________________________________________________________________________________

IN BANGLADESH:

1.________________________________________________________________________________________________________
2.________________________________________________________________________________________________________
20. HOW EXPENSES PROPOSED TO BE MET FOR STAT IN INDIA ( STATE FOREIGN
EXCHANGE AUTHORIZED) :__________________________________________________________________________
_____________________________________________________________________________________________________
 21. IF NOT CARRYING FOREIGN EXCHANGE, FURNISE SPONSORSHIP CERTIFICATE IN
PRESCRIBED FORM:

I ENCLOSE _________________________________________________________________COPIES IF THIS

APPLICATION ALONGWITH __________________________________________________________COPIES OF MY
RECENT PHOTOGRAPH.
I , HEREBY CERTIFY THAT THE INFORMATION FURNISHED ABOVE IS CORRECT AND
FURTHER UNDERTAKE THAT I SHALL UTILIZE MY VISIT TO INDIA FOR THE PURPOSE FOR WHICH THE
VISA HAS BEEN APPLIED FOR AND SHALL NOT ON ARRIVAL IN INDIA, TRY TO OBTAIN EMPLOYMENT OR
SET UP BUSINESS OR TO EXTEND MY STAY FOR ANY OTHER PURPOSE.

SIGNATURE_______________________________________

DATE_____________________________________________