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Visa Form
S. 109-A
APPENDIX 1
Para 3(1)(a)
PART-A
(Visa Application)
2. Whether any children accompanying applicant are included in his/her passport. If so give the
following details:-
3. Address :
a. Permanent
b. Present
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4. Date of Birth
5. Place of Birth
6. Present Nationality
8. Profession or Occupation
10. Have you visited India previously, if so indicate places with dates____________________
_______________________________________________________________________
11. Whether permission to visit India or to extend stay in India has been refused previously, if
so, when__________________________________________________
a. Transit
(Place/country to be visited further)
b. Tourism
(Places/areas to be visited)
c. Business
(Trade/Project/Scheme - Brief description to be given)
(Party/parties to be contacted)
d. Education
(Name and particulars of educational institutions)
e. Any other
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PART-B
4. Name and address of persons who will furnish information as to applicant and also
furnish financial guarantees for maintenance and repatriation if referred to :-
IN COUNTRY OF APPLICANT
(i)
(ii)
IN INDIA
(i)
(ii)
I, _________________________ hereby undertake that I shall utilise 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 extend my stay for any other purpose.
Date___________ Signature_____________________
(Clarification: There may be variations in forms issued by various Indian Missions - specific
requirements may be obtained from the concerned Mission by the applicant.)
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