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HIGH COMMISSION OF INDIA

DHAKA(BANGLADESH) Paste your unsigned


recent color photograph.
Size: 2” X 2”

Visa Application Form

Signature
BGDDV2889918

A. Personal Particulars (As in Passport)

Appointment Date : 30-JAN-2018 At : 8.15 Hrs.


Surname (As in Passport) HAQUE
Given Nam e (As in Passport) IMRANUL
Previous/other Name if any
Sex MALE Marital Status SINGLE
Date of birth 16-APR-1995 Religion ISLAM
MANIKGANJ BANGLADESH
Application Id :BGDDV2889918

Place of Birth Town/City Country of Birth


Citizenship /National ID No 19955624607008620 Educational Qualification HIGHER SECONDARY
Visible identification marks NIL
Current Nationality BANGLADESH Nationality by Birth/ Naturalization BY BIRTH
Any Other Previous/Past Nationality
B. Passport Details
Passport No. BR0146155 Date of issue ( dd/mm/yyyy ) 11-DEC-2017
Place of issue DHAKA Date of expiry (dd/mm/yyyy) 10-DEC-2022
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)
Web Registration Date : 23-JAN-2018

Nationality/status

Gulshan
C. Applicant’s Contact Details

26/16, MIDDLE PAIK PA Phone No 01677048082


Present
address MIRPUR Mobile /Cell No 1516368066
DHAKA, BANGLADESH 1216 Email address

Permanent SAOUT SHEWTA, W-01


Address MANIKGANJ SADAR, MANIKGANJ SADAR
MANIKGANJ

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
MANIKGANJ
Father’s MONIRUL HAQUE BANGLADESH BANGLADESH BANGLADESH
MANIKGANJ
Mother’s ANJU MONOARA BEGUM BANGLADESH BANGLADESH BANGLADESH

Spouse

Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO


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 15-FEB-2018
Port Of Arrival BY ROAD CHANGRABANDHA Port of Exit BY ROAD CHANGRABANDHA

IMRANUL HAQUE
Required Detail of TOURIST VISA
Places to be Visited KOLKATA

Purpose of Visit : TOURISM


F. Previous Visit Details
Have You Ever visited India ? NO
Address where You stayed in
India
,

Application Id :BGDDV2889918
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 ?
If yes above mention when and by whom with control
No/Date
G. Profession/Occupation Details of Father
Present Occupation STUDENT Designation/Rank OFFICE ASSISTANT
Employer name/business M A ROUF DEGREE COLLEGE
Employer Address MANIKGONJ, JHITKA, KOWRY
Phone Number
+8801710273723
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.
1 HOTEL ORIENTAL 9A, MARQUIS STREET KOLKATA WEST BENGAL. +91 33 2252 993,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India In BANGLADESH
Name HOTEL ORIENTAL ARIFUL HAQUE
Address 9A, MARQUIS STREET SAOUT SHEWTA, W-01
KOLKATA, WEST BENGAL MANIKGANJ SADAR, MANIKGANJ
Phone
+91 33 2252 993 01710273723
Number

J. 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.

..……………………………………
23-JAN-2018
Date :………………………. Applicant’s signature (as in Passport)