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Visa Application Form (as in passport) Surname Name Previous / other Name if any Sex Marital status Date of birth Religion Place of birth Country of birth Citizenship / National ID No Educational Qualification Visible identification marks Current Nationality Nationality by birth / Naturalization Any Other Previous / past nationality.
Visa Application Form (as in passport) Surname Name Previous / other Name if any Sex Marital status Date of birth Religion Place of birth Country of birth Citizenship / National ID No Educational Qualification Visible identification marks Current Nationality Nationality by birth / Naturalization Any Other Previous / past nationality.
Visa Application Form (as in passport) Surname Name Previous / other Name if any Sex Marital status Date of birth Religion Place of birth Country of birth Citizenship / National ID No Educational Qualification Visible identification marks Current Nationality Nationality by birth / Naturalization Any Other Previous / past nationality.
Surname Name 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 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 RUSM00530312 IVAN PETROV MOSCOW RUSSIAN FEDERATION RUSSIAN FEDERATION W e b
F i l e
N u m b e r
: R U S M 0 0 5 3 0 3 1 2 VLADIVOSTOK IVAN RUSSIAN FEDERATION RUSSIAN FEDERATION +79105674567 W e b
R e g i s t r a t i o n
D a t e
:
2 1 - A U G - 2 0 1 2 PETROVA OLGA 23-MAR-2010 23-MAR-2015 IVAN@MAIL.RU 6 Month PETROV Moscow BY BIRTH N/A MOSCOW KAZAN RUSSIAN FEDERATION NEW DELHI BELOYARSKIY, TYUMENSKIY REGION RUSSIAN FEDERATION SEVASTOPOLSKAYA STR. 15-45 MOSCOW MOSCOW 05-JUN-1975 RUSSIAN FEDERATION 6-8, Vorontsovo Polye Double PETROV VLADIMIR Male 4730389561 RUSSIAN FEDERATION 7152456454 Married NO +74991234567 www.indianembassy.ru NO (Month) PETROVA LIUDMILA Embassy of India 15-NOV-2012 TOURIST VISA PROFESSIONAL MOSCOW CHRISTIAN SEVASTOPOLSKAYA STR. 15-45 MOSCOW, RUSSIAN FEDERATION 121345 +7-495-9810093 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) PIROGOV ANDREY NO MOSCOW RUSSIAN FEDERATION INDIA, UKRAINE, BELARUS, ITALY, SPAIN, HUNGARY W e b
F i l e
N u m b e r
: R U S M 0 0 5 3 0 3 1 2 OOO IGRUSHKA ENGINEER KOMSOMOLSKAYA STR. 14-56 12-MAR-2009 21-AUG-2012 +74951221212 18, NOIDA-201301, NEW DELHI AP4534819 ENGINEER TVERSKAYA STR. 20 FF-10, ANSAL FORTUNE ARCADE SECTOR 4/68, W.E.A, KAROL BAGH, SARASWATI MARG, NEW DELHI - 110005 HOTEL JYOTI DELUXE VAMANA TRAVELS INDIA PVT LTD +911204236800 Places to be Visited +74957111111 YES TOURISM NEW DELHI, MUMBAI TOURIST VISA TOURIST VISA NEW DELHI, MUMBAI, VRINDAVAN