MINISTRY OF HOME
AFFAIRS
FOREIGN DIVISION
1. Name of the applicant Mr/Mrs/Miss ________________________________________
(in capital letters with surname
underlined)
2. Father’s name / husband’s name ___________________________________________________
3. Place & Date of Birth ___________________________________________________
4. Nationality 1. Present ___________________________________________________
2. Past ___________________________________________________
5. Occupation
( give also address of place of ___________________________________________________
work if employed )
6. Mailing address in
7. Permanent address ___________________________________________________
___________________________________________________
8. Reference a) in country of
applicant. ___________________________________________________
b)
in
9. Passport details : Number ___________________________________________________
___________________________________________________
10. Details of Visa for
No. _________________________ issued from _______________________________________
at __________________________ valid upto ________________________________________
11. Place proposed to be visited ___________________________________________________
12. Route intended to be followed ___________________________________________________
13. Likely date of visit ___________________________________________________
14. Purpose of visit ___________________________________________________
15. Likely duration of visit ___________________________________________________
16. If anyone accompanying the
applicant, if so give details ___________________________________________________
17. Arrangement for travel &
accommodation that have made ___________________________________________________
18. Details of previous visit to
if any ___________________________________________________
19. Has he/she/they previously
visited any restricted / Protected
Area in
20. Has any earlier request for permit
been refused, if so give details __________________________________________________
The information given above is correct and complete to the best of my knowledge.
Signature of the applicant.
Place :
Date :
...............................................................................................................................................
NOTE :
1. This
application is to be sent to the Ministry of Home Affairs (Foreign Division), Lok Nayak Bhavan,
2. It is advisable to make the application at least eight weeks before the proposed visit.
3. Applications
outside
4. 2 (two) passport photographs should be enclosed.