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    Applicant I004VF11992433

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    jjyoti

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    © All Rights Reserved
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    Applicant I004VF11992433

    Uploaded by

    jjyoti
    16 views3 pages

    Original Title

    Applicant_I004VF11992433

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    16 views3 pages

    Applicant I004VF11992433

    Uploaded by

    jjyoti

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 3

    DELHI AIRPORT

    e-Visa Paste your unsigned


    recent color photograph.
    ENABLED BY ETA Size: 2" X 2"

    e-Visa Application Form

    Signature

    I004VF119924

    A. Personal Particulars (As in Passport)


    Surname JEEVAN JYOTI
    Given Name JEEVAN JYOTI
    Previous Name
    Gender FEMALE Marital Status MARRIED
    Date of Birth 16/05/1985 Religion HINDU
    Place of Birth PATHANKOT Country of Birth INDIA
    File Ref No : I004VF119924

    Nationality AUSTRALIA
    Identification
    marks CUT MARK NEAR THE LEFT EYEBROW
    B. Passport Details
    Passport No. RA1831154 Date of Issue 21/12/2022
    Place of Issue AUSTRALIA Date of Expiry 21/12/2032
    Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
    Country of Issue Place of Issue
    Passport/IC No. Place of Issue
    C. Applicant's Contact Details
    Present Address 433/11 EPPING PARK DRIVE EPPING NEW SOUTH WALES
    Mobile 61422513389 Email JEEVANJYOTI85@GMAIL.COM
    D. Family Details
    Relation Name Nationality Prev. Nationality Place of birth
    Father's JANAK RAJ INDIA PATHANKOT
    Mother's KARTAR KAUR INDIA GHOT POKHAR
    Spouse's DEEPAK SINGH AUSTRALIA INDIA DELHI
    Were your Parents/Grandparents (paternal/maternal) Pakistan Nationals or Belong
    to Pakistan held area. NO
    E. Visa Details
    Visa Service eTourist Visa(for 1 Year)
    Period of visa 1 YEAR No. of entries Multiple
    Journey Date 24/01/2025 Port of Exit DELHI AIRPORT
    F. Purpose Details
    Purpose of Visit MEETING FRIENDS/RELATIVES
    1) Places to be visited1 PUNJAB
    2) Places to be visited2 DELHI
    3) Have you booked any room in Hotel/Resort etc. through any
    Tour Operator? NO
    4) Name of the tour operator
    5) Address of the tour operator
    6) Name of Hotel/Resort etc
    7) Place/City of Hotel/Resort etc
    8) Details of the Friend/Relative NEHA WALIA
    9) Address D10 RD APRTAMENT, PLOT 20, SECTOR-6, DWARKA
    10) State DELHI
    11) District NEW DELHI
    File Ref No : I004VF119924 :: Registration Date :03/OCT/2024

    12) Phone no 9811215391


    13) Have you ever been arrested/ prosecuted/ convicted by
    Court of Law of any country? NO
    14) Have you ever been refused entry / deported by any
    country including India? NO
    15) Have you ever been engaged in Human trafficking/ Drug
    trafficking/ Child abuse/ Crime against women/ Economic
    offense / Financial fraud? NO
    16) Have you ever been engaged in Cyber crime/ Terrorist
    activities/ Sabotage/ Espionage/ Genocide/ Political killing/
    other act of violence? NO
    17) Have you ever by any means or medium, expressed views
    that justify or glorify terrorist violence or that may encourage
    others to terrorist acts or other serious criminal acts? NO
    18) Have you sought asylum (political or otherwise)in any
    country? NO
    19) evisa_fee 40
    G. Profession/Occupation Details
    Present
    Occupation PRIVATE SERVICE Designation/Rank QUALITY MANAGER
    Employer name/business EMVISION MEDICAL DEVICE PTY LTD
    SUITE 4/65 EPPING ROAD,
    Employer Address MACQUARIE PARK, NSW 2113 Employer Phone 02 8667 5337
    H. Details of Two Reference
    In India In AUSTRALIA
    Name NEHA WALIA SANDEEP ARYA
    D10 RD APRTAMENT, PLOT 20, 29 MOWBRAY CIRCUIT
    SECTOR-6, DWARKA NEW
    Address DELHI DELHI NORTH KELLYVILLE, NSW 2155
    Phone 9811215391 61450400010
    I. 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.
    Date :03/OCT/2024

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