ASSISTANT HIGH COMMISSION OF INDIA

CHITTAGONG(BANGLADESH)
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Visa Application Form

Specimen Signature
BGDC00186710

A. Personal Particulars (As in Passport)

Surname SARWAR

Appointment Date : 17-AUG-2010 At : 9.45

Name RASHED SARWAR
Previous/other Name if any
Sex Male Marital Status Married
Date of birth 30-JUN-1976 Religion ISLAM
Place of Birth Town/City CHITTAGONG Country of Birth BANGLADESH
Citizenship /National ID No 2693622289218 Edu.Qualification POST GRADUATE
Visible identification marks CUT OF RIGHT FOREHEAD
Current Nationality BANGLADESH Nationality by Birth/ Naturalization By Birth
Any Other Previous/Past Nationality
Web File Number :BGDC00186710

B. Passport Details
Passport No. V0179274 Date of issue ( dd/mm/yyyy ) 10-AUG-2003
Place of issue CHITTAGONG Date of expiry (dd/mm/yyyy) 09-AUG-2013
Any other Passport/Identity Certificate(IC) held (if yes ,please fill in the following) NO
Country of issue Place of issue
Passport/IC No Date of issue(dd/mm/yyyy)
Nationality/status
C. Applicant’s Contact Details
Present address Phone No 031-650601
ANKUR 104/A, SHOLUCKBAHAR.
Mobile /Cell No 01199800443
CHITTAGONG
Web Registration Date : 13-AUG-2010

CHITTAGONG, BANGLADESH Email address rsarwar.sale@yahoo.com

Permanent
ANKUR 104/A, SHOLUCKBAHAR.
address
CHITTAGONG
CHITTAGONG

D. Family Details
Father's Name MOHAMMAD BUDSHA MIAH Father's Nationality BANGLADESH
Mother's Name JAMAL HASINA BEGUM Mother's Nationality BANGLADESH
Spouse Name FARHANA AMAN Spouse Nationality BANGLADESH
Were your Grandfather/Grandmother(paternal/maternal) Pakistan nationals Or belong to Pakistan held area NO
:
E. Details of Visa Sought
Type Of Visa Required
TOURIST VISA No of Entries
Single
Period of Stay/Visit 30 Days Expected Date of Journey 18-AUG-2010
Port Of Arrival BY AIR Port of Exit BY AIR

RASHED SARWAR SARWAR

Required Detail of TOURIST VISA

Web File Number :BGDC00186710

Purpose of Visit : MEETING FRIENDS/RELATIVES
F. Previous Visit Details
Have You Ever visited India ? YES
Address where You stayed in HINDUSTAN UNILEVER, KOLKATA
India ,
Cities in India Visited KOLKATA
Type of Visa CONFERENCE VISA Visa Number Z892740
Visa Issued Place DHAKA Date of Issue 20-NOV-2007
Countries visited in last 10 years
SAUDI ARABIA CHINA THAILAND SINGAPORE, MALAYSIA
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
Present Occupation OTHERS Designation/Rank
Employer name/business NA
Employer Address NA
Phone Number
Past occupation if any OFFICIAL
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 Addr ess of Place / Hotel , Email address/ Phone No.
1 TAPAS MONDAL F-31,UJJALA APARTMENT, 1B,CHANDI GHOSH ROAD,KOLKAT KOLKATA WEST BENGAL . 9830417514, tmondal@apac.ko.com
2 .,
3 .,
4 .,
I. Details of Two Reference
In India In BANGLADESH
Name TAPAS MONDAL S H ASLAM HABIB
Address FLAT-31,UJJALA APARTMENT,1B,CHANDI DBH, LANDMARK(11 FLOOR)12-14,
GHOSH ROAD KOLKATA WEST BENGAL GULSHAN, DHAKA
Phone Number 9830417514 01611526367

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.

..……………………………………
13-AUG-2010
Date :………………………. Applicant’s signature (as in Passport)