Indian Visa Application

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HIGH COMMISSION OF INDIA

DHAKA(BANGLADESH) Paste your unsigned


recent color photograph.
Size: 2" X 2"

Visa Application Form

Signature
BGDDV782A022

A. Personal Particulars (As in Passport)


Surname (As in Passport) YOUNUS
Application Id : BGDDV782A022

Given Name (As in Passport) MD


Previous/other Name if any Not Applicable
Gender MALE Marital Status SINGLE
Date of Birth 08-OCT-2000 Religion ISLAM
Place of Birth Town/City DHAKA Country of Birth BANGLADESH
Citizenship /National ID No 1032495184 Educational Qualification GRADUATE
Visible identification marks NA
Current Nationality Nationality by Birth/
BANGLADESH Naturalization BY BIRTH
Any Other Previous/Past Nationality Not Applicable
B. Passport Details
Passport No. A04153529 Date of Issue ( dd/mm/yyyy ) 01-JUN-2022
Place of Issue DHAKA Date of Expiry ( dd/mm/yyyy ) 31-MAY-2027
Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Web Registration Date : 18-JUL-2022

Country of Issue Place of Issue


Passport/IC No. Date of issue (dd/mm/yyyy)
Nationality/Status
C. Applicant's Contact Details
NORTH,NAYANAGAR,TURAG,U
Present TTARA Phone No
Address DHAKA Mobile /Cell No 88001880089102
DHAKA, BANGLADESH 1230 Email address TRAVELFORING@GMAIL.COM

Permanent 22,PURANKALIA
Address NAYANAGAR,TURAG,UTTARA
DHAKA

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
DHAKA
Father's MD SAMSER ALI BANGLADESH BANGLADESH BANGLADESH
DHAKA
Mother's MAKSUDA BEGUM BANGLADESH BANGLADESH BANGLADESH
Marital
Status Single
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO

MD YOUNUS
E. Details of Visa Sought (Visa shall be valid from the Date of Issue and not from the Date of Journey)
Type Of Visa Required TOURIST VISA No of Entries MULTIPLE
Period of Visa ( Month) 12 Month Expected Date of Journey 04-AUG-2022
Port Of Arrival BY ROAD CHANGRABANDHA Port of Exit BY ROAD CHANGRABANDHA
Required Detail of TOURIST VISA
Places to be Visited TOURIST

Purpose of Visit : TOURISM,RECREATION,SIGHT-SEEING


F. Previous Visit Details
Have You Ever visited India ? NO
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 NA
Have you been refused an Indian Visa or extension of the same previously or deported

Application Id : BGDDV782A022
from India ? NO
G. Profession/Occupation Details :
Present Occupation PRIVATE SERVICE Designation/Rank MANAGER AND TOUR HOST
Employer name/business TRAVEL AGENCY
Employer Address UTTARA,11 SECTOR ,14 ROAD ,HOUSE 76,DHAKA
Phone Number 01880089102
Past occupation if any PRIVATE SERVICE
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 State Phone No
1 DARJEELING HOTEL SUMMER PALACE HILL CART RD, CHAUK BAZAAR, DARJEELING, WEST BENGA DARJILING
WEST BENGAL. 70475 69156,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India In BANGLADESH
Name PRADEEP MD DIN ISLAM RAZ
HILL CART RD, CHAUK
BAZAAR, DARJEELING,
Address WEST BENGAL 734101 DIABARI,UTTARA ,TURAG,DHAKA 1230
DARJILING WEST BENGAL
Phone Number 91 70475 69156 01880089100
K. 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.
e. I will also submit hard-copy all the uploaded documents along with the print of application to submit to the concerning Indian
Mission or Agency for processing of visa application.

18-JUL-2022 ................................
Date : ...................... Applicant's signature (as in Passport)

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