Visa Application Form

A. Personal Parti cul ars (As in Passport)

Surname (As in Passport)
Given Name (As in Passport)
Previous/other Name if any
Sex Marital Status
Date of birth Religion
Place of Birth Town/City Country of Birth
Citizenship /National ID No Educational Qualification
Visible identification marks
Current Nationality Nationality by Birth/ Naturalization
Any Other Previous/Past Nationality
B. Passport Detai l s
Passport No. Date of issue ( dd/mm/yyyy )
Place of issue Date of expiry (dd/mm/yyyy)
Any other Passport/Identi ty Certi fi cate hel d (i f yes ,pl ease fi ll i n the foll owing)
Country of issue Place of issue
Passport/IC No Date of issue(dd/mm/yyyy)
Nationality/status
C. Appl icant s Contact Detail s
Phone No
Mobile /Cell No

Present
address

Email address

Permanent
Address

D. Famil y Detail s

Rel ati on Name Nati onali ty Prev. Nat ional ity Pl ace/Country of Birth
Fathers
Mothers
Spouse
Were your Grandfather/Grandmother(Paternal/Maternal ) Paki stan Nati onals Or bel ong to Paki stan hel d area :
E. Detail s of Vi sa Sought (Visa shall be valid from the Date of Issue and not from the Date of J ourney)
Type Of Visa Required No of Entries
Period of Visa Expected Date of J ourney
Port Of Arrival Port of Exit


Paste your unsigned
recent color photograph.
Size: 2 X 2


Signature
MDVMV03B2D13
ALI MOHAMED
MALDIVES IMMIGRATIOM
MALDIVES
MALDIVES
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3
B
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N.MAAFARU
ALI
MALDIVES
7758030
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R
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0
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3
THIRUVANANTHAPURAM AIRPORT
02-MAY-2012
02-MAY-2017
3 Month
MOHAMED
Male, Republic of Maldives
BY BIRTH
NONE
N.MAAFARU
HDH,KULHUDHUFFUSHI
MALDIVES
THIRUVANANTHAPURAM AIRPORT
MA.KENDHIVARU
KAAFU/MALE
MACHANGOLHI
02-JAN-1942
MALDIVES
H. Athireege Aage, Ammeru Ahmed Magu
Single
MOHAMED
Male
A080982
MALDIVES
E0422479
Un-Married
NO
http://www.hcimaldives.com/
NO
(Month)
FATHMATH AHMED
High Commission of India
15-SEP-2013
MEDICAL VISA
OTHERS
KAAFU/MALE
ISLAM
MA.KENDHIVARU
MACHANGOLHI, MALDIVES 20248
960-3323015
Required Detail of

Purpose of Visit :
F. Previ ous Vi si t Detail s
Have You Ever visited India ?
Address where You stayed in
India

Cities in India Visited
Type of Visa Visa Number
Visa Issued Place Date of Issue
Countries visited in last 10 years
Have you been refused an Indian Visa or extension of the same previously or deported from India ?
If yes above mention when and by whom with control
No/Date

G. Professi on/Occupati on Detail s
Present Occupation Designation/Rank
Employer name/business
Employer Address
Phone Number

Past occupation if any
Are/have you worked with Armed forces/ Police/ Para Military forces ?
Organization Designation
Place of Posting Rank
H. Address of Place of Stay / Hotel
Place/Hotel Name Address of Place / Hotel State Phone No.

I. Detail s of Two Reference
In Indi a In
Name
Address
Phone
Number


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.




..
Date :. Applicants signature (as in Passport)
JEESHAN ALI
NO
MALDIVES
INDIA, SRILANKA
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3
NA
UN-EMPLOYED
MA,KENDHIVARU
09-SEP-2013
7867388
NA
HOTEL ASHISH
,
PREM
+919847709998
Phone/Fax
Details
Address
Doctor Name
Hospital Name
NO
MEDICAL TREATEMENT OF SELF
KIMS HOSPITAL
KIMS HOSPITAL
ADK HOSPITAL
ADK HOSPITAL/SOSUN MAGU/MALE,REP OF MALDIVES
DR JASON
MEDICAL VISA