APPLICATION FORM

( Registration Extension )

2011198SY507

Application ID No. 2011198SY507 Final Submission Date Sat Nov 23 09:42:22 IST 2019

FOR OFFICE USE ONLY

Reg. No. S 4 7 7 L K A 2 0 2 0

Personal Details
Surname DAMBADENIYA ARACHCHIGE
Given Name YOHAN THIWANKA DAMBADENIYA Paste your
Sex Male Date of Birth 18/07/1997 Height (in cm) 172 Recent passport size
Age as on today Year(s) 22 Month(s) 6 Day(s) 10 photograph here
Place of Birth COLOMBO,COLOMBO,SRI LANKA
Father's Name DAC DAMBADENIYA
Mother's Name BK PREMASEELI
Spouse's Name
Religion BUDDHISM Any Identification mark(s) preferably BIRTH MARK ON THE RIGHT
visible SIDE OF THE FACE

Present nationality SRI LANKA Previous nationality

Manner of acquiring present nationality Birth
Date of acquiring present nationality 18/07/1997
Whether holding dual NO
nationality? If yes, Name of the country of second nationality
provide the following:- Passport No. of second country
Date of Issue
Date of Expiry
Whether travelled on this passport earlier to
India

Whether person of Indian Origin NO

Address of last residence (Outside India)

Address SURIYA SEWANA,FINANCE WATTA,INGIRIYA WATTA B INGIRIYA
City INGIRIYA Country SRI LANKA

Address intended for longer stay in India (Registration)

Address 1E,GOMTI BLOCK,INS SHIVAJI,LONAVLA
City/ District PUNE State MAHARASHTRA
Pin Code 410402
Phone Number Mobile Number 9403438749
Any Other Address in India
Address
City/ District State
Pin Code
Phone Number Mobile Number
Email/Occupation/Profession Details
E-Mail Id yohanthiwanka11111@gmail.com
Profession/Occupation NAVY

Passport Details
Passport Number N7910829 Place of Issue SRI LANKA, COLOMBO
Date of Issue 05/11/2018 Expiry Date 05/11/2028

Visa Details
Visa Number VL0778130 Place of Issue SRI LANKA, COLMBO
Date of Issue 12/11/2018 Expiry Date 20/08/2020
Valid For Multiple Entry Visa Type ENTRY VISA
Special endorsement, if any

Organization/Company/Institute/Hospital Details
Name
Address

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 2011198SY507
Application ID No. 2011198SY507

State City
Telephone Number Email ID
Employer EPFO ID Establishment ID
Arrival Details
Place of embarkation/boarding for India BANDARANAIKE INTERNATIONAL AIRPORT,COLOMBO,SRI LANKA
Date of arrival in India 17/11/2018
Place of disembarkation/arrival in India MUMBAI AIRPORT
Mode of Journey Air Flight/ Ship/ Bus/ Train No.
Purpose of visit to India Education

Previous Registration Details in India

Registration Number Place of Registration Visa Type Duration From To
MH1200073118 MAHARASHTRA,PUNE ENTRY VISA 29/11/2018 29/11/2019
Details of family members/attendant/dependents, if any accompanying.
Name Nationality Passport Number Relationship
Person to be contacted in Case of Emergency
Name DAC DAMBADENIYA Relationship FATHER
Address SURIYA SEWANA,FINANCE WATTA,INGIRIYA WATTA City INGIRIYA
B, INGIRIYA
Country SRI LANKA Phone Number 0094763959139
Category Others

Military service details

Organisation SRI LANKA NAVY Designation TRAINEE
Rank ERA APPRENTICE Place of Last Posting COLOMBO
Country of Last Posting SRI LANKA

Current Registration Details

Are you registered in current locality FRRO/FRO in the current visit? YES Current MH1200073118
Registration No.

Registration Extension Details

Current Registration Valid Upto 29/11/2019 Required for period of Year(s) 0 Month(s) 9 Day(s) 15
Reason Of Extension EXPIRY OF REGISTRY RP

Signature of the Applicant

Date_ _ _ _ _ _ _ _ _ _ _ _ _

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 2011198SY507
Application ID No. 2011198SY507

List of mandatory and non mandatory documents

Mandatory Documents.
1. Residence proof : Updated Form 'C' generated by Hotel/Lodge or Registered/ Notarized Lease Deed, Utility Bill, Copy of photo-ID of the landlord along with declaration and Tenant
Police Verification

2. Undertaking from Sponsor/ Parents : Undertaking of parents along with Passport and Visa/OCI copies (in case of minors)
3. Photo : Applicant's Photo
4. Registration Certificate and Stay Visa : FRRO/FRO Registration Certificate and Stay Visa (if any) of the applicant and the principal visa holder
5. Visa : Indian Visa
6. Passport : Bio-Data page of Passport along with page bearing last Indian Immigration arrival stamp
7. Registration Certificate : FRRO/FRO Registration Certificate/Residential Permit of the Entry (X-Misc) Visa holder

Registration office address

Office Name : FRO PUNE RURAL

Address : Superentendent of Police, Chavan Nagar, Pashan Road, Pune-8
City/District : PUNE
State : MAHARASHTRA
Pin Code : 0
Phone Number : 02026128977

Office opening time: 10.00 closing time: 17.00

There is no need to submit hard copy to concerned

FRRO/FRO

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