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    BGDRV1368F22DW800701

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    alamgir80
    This document is a visa application form submitted by Dwibyendranath Shaha to visit India. [1] He is applying for a 12-month multiple entry tourist visa to visit places like Goya, Kashi, and Brinaban for purposes of tourism, recreation and sightseeing. [2] Dwibyendranath was born in Rajshahi, Bangladesh and works as a high school teacher in Bangladesh. [3] He declares that the information provided is complete and correct and that he will abide by the conditions for visiting India.

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    © All Rights Reserved
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    BGDRV1368F22DW800701

    Uploaded by

    alamgir80
    364 views2 pages
    This document is a visa application form submitted by Dwibyendranath Shaha to visit India. [1] He is applying for a 12-month multiple entry tourist visa to visit places like Goya, Kashi, and Brinaban for purposes of tourism, recreation and sightseeing. [2] Dwibyendranath was born in Rajshahi, Bangladesh and works as a high school teacher in Bangladesh. [3] He declares that the information provided is complete and correct and that he will abide by the conditions for visiting India.

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    This document is a visa application form submitted by Dwibyendranath Shaha to visit India. [1] He is applying for a 12-month multiple entry tourist visa to visit places like Goya, Kashi, and Brinaban for purposes of tourism, recreation and sightseeing. [2] Dwibyendranath was born in Rajshahi, Bangladesh and works as a high school teacher in Bangladesh. [3] He declares that the information provided is complete and correct and that he will abide by the conditions for visiting India.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    364 views2 pages

    BGDRV1368F22DW800701

    Uploaded by

    alamgir80
    This document is a visa application form submitted by Dwibyendranath Shaha to visit India. [1] He is applying for a 12-month multiple entry tourist visa to visit places like Goya, Kashi, and Brinaban for purposes of tourism, recreation and sightseeing. [2] Dwibyendranath was born in Rajshahi, Bangladesh and works as a high school teacher in Bangladesh. [3] He declares that the information provided is complete and correct and that he will abide by the conditions for visiting India.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    ASST HIGH COMMISSION OF INDIA RAJSHAHI

    HOUSE NO-284, SECTOR-2,HOUSING ESTATE Paste your unsigned


    recent color photograph.
    UPOSHAHAR,RAJSHAHI Size: 2" X 2"
    00880721861213

    Visa Application Form

    Signature

    A. Personal Particulars (As in Passport)


    Surname (As in Passport) SHAHA
    Given Name (As in Passport) DWIBYENDRANATH
    Previous/other Name if any Not Applicable
    Gender MALE Marital Status MARRIED
    Date of Birth Religion HINDU
    Place of Birth Town/City RAJSHAHI Country of Birth BANGLADESH
    Citizenship /National ID No 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. Date of Issue ( dd/mm/yyyy ) 22-MAY-2022
    Place of Issue DIP DHAKA Date of Expiry ( dd/mm/yyyy ) 21-MAY-2032
    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. Applicant's Contact Details
    Present Phone No
    Address Mobile /Cell No
    Email address

    Permanent
    Address

    D. Family Details
    Relation Name Nationality Prev. Nationality Place/Country of Birth
    RAJSHAHI
    Father's BANGLADESH BANGLADESH BANGLADESH
    NAOGAON
    Mother's BANGLADESH BANGLADESH BANGLADESH
    NAOGAON
    Spouse BANGLADESH BANGLADESH BANGLADESH
    Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO

    DWIBYENDRANATH SHAHA
    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 30-JUN-2022
    Port Of Arrival BY ROAD HILI Port of Exit BY ROAD HILI
    Required Detail of TOURIST VISA
    Places to be Visited GOYA, KASHI, BRINABAN ETC

    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
    Have you been refused an Indian Visa or extension of the same previously or deported
    from India ? NO
    G. Profession/Occupation Details :
    Present Occupation HIGH SCHOOL TEACHER Designation/Rank ASSISTANT TEACHER
    Employer name/business
    Employer Address
    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 State Phone No

    2 .,
    3 .,
    4 .,
    I. Details of Two Reference
    In India In BANGLADESH
    Name AJIT PAUL BEAUTY PRAMANIK
    Address

    Phone Number
    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.

    19-JUN-2022 ................................
    Date : ...................... Applicant's signature (as in Passport)

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