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DHAKA(BANGLADESH)

Visa Application Form

Signature

BGDDY40AF516

Previous/other Name if any

Sex

Web Registration Date : 03-SEP-2016

Application Id :BGDDY40AF516

Date of birth
Place of Birth Town/City
Citizenship /National ID No
Visible identification marks
Current Nationality

FEMALE
17-JAN-1983
NATORE
19834792105015583
NIL
BANGLADESH

Marital Status
Religion
Country of Birth
Educational Qualification

MARRIED
HINDU
BANGLADESH
BELOW MATRICULATION

Nationality by Birth/ Naturalization

BY BIRTH

Date of issue ( dd/mm/yyyy )

18-AUG-2016
17-AUG-2021

Any Other Previous/Past Nationality

B. Passport Details

BL0640589
DHAKA

Passport No.
Place of issue

Date of expiry (dd/mm/yyyy)

Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Country of issue

Place of issue

Passport/IC No

Date of issue(dd/mm/yyyy)

Nationality/status
C. Applicants Contact Details
Present
address

238, PABLA BANIK PARA

DAULATPUR, DAULATPUR
KHULNA, BANGLADESH 9202

Phone No
Mobile /Cell No

01612991005
1612991005

Email address

Permanent 238, PABLA BANIK PARA

Address
DAULATPUR, DAULATPUR
KHULNA
D. Family Details
Relation

Name

Nationality

Prev. Nationality

Place/Country of Birth

Fathers

SREE NEPAL CHANDRA PAUL NAREN

BANGLADESH

BANGLADESH

NATORE
BANGLADESH

Mothers

SREEMOTI MINOTI RANI PAUL

BANGLADESH

BANGLADESH

NATORE
BANGLADESH

Spouse

BIPLOB PAUL

BANGLADESH

BANGLADESH

KHULNA
BANGLADESH

Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO

E. Details of Visa Sought

(Visa shall be valid from the Date of Issue and not from the Date of Journey)

TOURIST VISA
(Month) 12 Month
BY AIR/ HARIDASPUR

Type Of Visa Required

Period of Visa
Port Of Arrival

PROVATY RANI PAUL

No of Entries
Expected Date of Journey
Port of Exit

MULTIPLE
30-OCT-2016
BY AIR/ HARIDASPUR

Appointment Date : 21-SEP-2016 At : 8.45

A. Personal Particulars (As in Passport)

Surname (As in Passport)
PAUL
Given Nam e (As in Passport) PROVATY RANI

Required Detail of

TOURIST VISA
KOLKATA

Purpose of Visit : TOURISM

F. Previous Visit Details
Have You Ever visited India ?
Address where You stayed in
India

NO

Cities in India Visited

Type of Visa
Visa Issued Place
Countries visited in last 10 years

Visa Number
Date of Issue

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. Profession/Occupation Details of Spouse
Present Occupation HOUSE WIFE
Designation/Rank
HOUSE WIFE
Employer name/business PROVATY RANI PAUL
Employer Address DAULATPUR, KHULNA
Phone Number
Past occupation if any
Are/have you worked with Armed forces/ Police/ Para Military forces ? NO
Organization
Designation
Place of Posting
Rank
H. Address of Place of Stay / Hotel
Place/Hotel Name
Address of Place / Hotel

1 PATHARGHATA RAJARHAT NORTH 24 PARGANAS WEST BENGAL. 00919775644312,

2 .,
3 .,
4 .,
I. Details of Two Reference
In India
In
BIPLOB PAUL
Nam e ASHOK KUMAR PAUL
Address PATHARGHATA , RAJARHAT
238, PABLA BANIK PARA
NORTH 24 PGS, WB.

Phone
00919775644312
Number

State

Phone No.

BANGLADESH

DAULATPUR, KHULNA
01712991005

J. DECLARATION:
a.
b.
c.
d.

I do not hold any other passport(s) other than those detailed above.
I have read and understood all the conditions for the visit to India and I am willing and able to abide fully by them.
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.
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.

03-SEP-2016
Date :.

..
Applicants signature (as in Passport)

Application Id :BGDDY40AF516

Places to be Visited