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APPLICATION FORM

( Visa extension )

1906128RYNQ3 Application ID No. 1906128RYNQ3 Appointment Date FOR OFFICE USE ONLY Reg.No. S 0 0 1 F R A 2 0 1 2 20/06/2012

Personal Details

Newly Born case


Paste your Recent passport size photograph here

Surname AROUMOUGAME Given Name RAJALAKSHMI Sex Female Date of Birth 01/11/1986 Age as on today Year(s) 25 Month(s) Place of Birth PONDICHERRY,PONDICHERRY,INDIA Father's Name AROUMOUGAME Mother's Name DOURERADJOU OLIMATHY Spouse Name VENGADESH KUMAR Any Identification mark(s) preferably visible MOLE ON NOSE Present nationality FRANCE Manner of acquiring present nationality By Birth Date of acquiring present nationality 05/05/2010 Whether holding dual NO nationality? If yes, Name of the country of second nationality provide the following:- Passport No. of second country Date of Issue Date of Expiry Whether travelled on this passport earlier to India

Height (in cm) 7 Day(s)

150 18

Previous nationality

INDIA

Whether person of Indian Origin


Address City NIL NIL

NO

Address of last residence (Outside India)


Country OTHERS

Address intended for longer stay in India (Registration)


Address NO 6 1ST CROSS GNANAPRAGASAM NAGAR LAWSPET POST City/District PONDICHERRY State Pin Code 605008 Phone Number 0413-2240952 Mobile Number PUDUCHERRY 9443209101

Any Other Address in India


Address City/District Pin Code Phone Number State Mobile Number

Email/Occupation/Profession Details
E-Mail Id a.rajalakshmi1986@gmail.com Profession/Occupation ENGINEER

Passport Details
Passport No. Date of Issue 10AV33771 05/05/2010 Place of Issue Expiry Date INDIA, PONDICHERRY 04/05/2020

Visa Details
Visa Number ESI105162010 Date of Issue 05/05/2010 Valid For Multiple Entry Special endorsement, if any Place of Issue Expiry Date Visa Type VISA EXTENDED UPTO 04 MAY 2012 INDIA, PONDICHERRY 04/05/2011 ENTRY VISA

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1906128RYNQ3 Application ID No. 1906128RYNQ3 Appointment Date 20/06/2012

Organization/Company/Institute/Hospital Details
Name Address State Telephone Number

City Email ID

Arrival Details
Place of embarkation/boarding for India Date of arrival in India Place of disembarkation/arrival in India Mode of Journey Purpose of visit to India NIL,NIL,

Flight /Ship /Bus /Train No.

Previous Registration Details in India


Registration Number Name Place of Registration Nationality Visa Type Duration From Passport Number FATHER INDIA To

Details of family members/attendant/dependents, if any accompanying.


Relationship

Person to be contacted in Case of Emergency


Name AROUMOUGAME Relationship Address NO 6 1ST CROSS GNANAPRAGASAM NAGAR LAWSPET POST City PONDICHERRY Country Phone Number 9443209101

Category

Others

Military service details


Organisation Rank Country of Last Posting Designation Place of Last Posting

Current Registration/Extension No.


Current Registration No. ESI105162010 Current Extension No. ESI105162010

Visa Extension Details


Wether Previously in India? Whether Permission to stay in India has been Previously refused? Whether Permission to extend stay in India has been Previously granted? Period of Extension requried Year(s) 1 Month(s) Reason for extension STAYING WITH HUSBAND In case of Missionary - Nature of work

12

Day(s)

Signature of the Applicant Date_ _ _ _ _ _ _ _ _ _ _ _ _

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1906128RYNQ3 Application ID No. 1906128RYNQ3 Appointment Date 20/06/2012

Instruction

Registration office address


Office Name Address City State Pin Code Phone Number : : : : : : FRO - Puducherry Office of the FRO, Housing Board Complex,III Floor, Anna Nagar, Nellithope PONDICHERRY PUDUCHERRY 0413-2201605

Office opening time: 9.30 Applications are accepted upto 15.00

closing time:

18.00

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