PAKISTAN HIGH COMMISSION

2/5-G. SHANIPATH, CHANAKYAPURI, NEW DELHI

-
1. Name: ---:_

2. Father's/Husband Name _
Paste your recent
photograph
& Occupation _

3. Address: _

____________________ Telephone No. _ -

4. Passport No. Issued at : _

5. Date of issue: Valid upto Religion

6. Date of Birth: (a) Place of birth (c) Sex: _

.7. (a) Height (b) Colour of eyes (c) Colour of hair: _

8. Occupation (Previous occupation if retired) : _

9. Do you belong or have belonged to Military/Semi Military, Police .org. ? Yes/No

10. If answer to either question at S. NO.9 is "Yes" Please state your present / past rank & full name of the

orga'1izflti.')'1 : --...;;....-------'--------------------------------------

1 i. Date of return from iast visit to PaKistan (if any) :

12. I will enter within days and stay days in Pakistan

13. Purpose of visit (give fuii detaiis) : _

14. Details of children mentioned in your passport who will be travelling with you:

S.No. Name Date of Birth Sex

 Particulars of persons and places to be visited in Pakistan

;
No.
•
" Name Father's/Hus-
DistrictTcmn
Number
Tehsil/
House
Telephone
Village/No:
Street/Mohallah
,
-

Request for Entry and Exit from different point (if required)

Entry: Exit: _

Mo<;leof travel: By Bus

By Air I. By Train I I On Foot I
I. I undertake that during my stay in Pakistan on visa, neither
I shall apply for Pakistan citizenship nor will any Pakistani
Relation of mine apply for an emergency certificate for me.

Signature/Thumb Impression of Appiicant

FOR OFFICIAL USE

I) ViS;3 Issued No. dated Valid for entry within days from the date uf

Issue and for stay of days for places aliowed in visa stamped in passport.

Aiso vaiid for childien mentioned at serial No. 14

I} Authority (if any) _

:) Check-Post of Entry/Exit, Specify only if entry and Exit permitted from different airports

Entry: Exit : _

VISA OFFICER
PAKISTAN HIGH COMMiSSiON
NEW DELHI