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  • Frro 20120919234801100 WM

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    sirftum99
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    APPLICATION FORM 190912LVIEAC Appointment Date and Time for OFFICE USE ONLY Reg.No. B 0 0 1 A F G 2 0 1 2 20 / 09 / 2012 10. Personal Details Surname Given Name AMIR GUL Sex Male Date of Birth 18 / 05 / 1979 Age as on today Year(s) 33 Month(s) Place of Birth LOGER,LOGER,AFGHANISTAN Father's Name SALAM GUL Mother

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    APPLICATION FORM 190912LVIEAC Appointment Date and Time for OFFICE USE ONLY Reg.No. B 0 0 1 A F G 2 0 1 2 20 / 09 / 2012 10. Personal Details Surname Given Name AMIR GUL Sex Male Date of Birth 18 / 05 / 1979 Age as on today Year(s) 33 Month(s) Place of Birth LOGER,LOGER,AFGHANISTAN Father's Name SALAM GUL Mother

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    Attribution Non-Commercial (BY-NC)
    Descărcați ca PDF, TXT sau citiți online pe Scribd
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    33 vizualizări3 pagini

    Frro 20120919234801100 WM

    Încărcat de

    sirftum99
    APPLICATION FORM 190912LVIEAC Appointment Date and Time for OFFICE USE ONLY Reg.No. B 0 0 1 A F G 2 0 1 2 20 / 09 / 2012 10. Personal Details Surname Given Name AMIR GUL Sex Male Date of Birth 18 / 05 / 1979 Age as on today Year(s) 33 Month(s) Place of Birth LOGER,LOGER,AFGHANISTAN Father's Name SALAM GUL Mother

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    Attribution Non-Commercial (BY-NC)
    Descărcați ca PDF, TXT sau citiți online pe Scribd
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    din 3

    APPLICATION FORM

    ( Registration )

    190912LVIEAC Application ID No. 190912LVIEAC Appointment Date and Time FOR OFFICE USE ONLY Reg.No. B 0 0 1 A F G 2 0 1 2 20/09/2012 10.30

    Personal Details
    Surname Given Name AMIR GUL Sex Male Date of Birth 18/05/1979 Age as on today Year(s) 33 Month(s) Place of Birth LOGER,LOGER,AFGHANISTAN Father's Name SALAM GUL Mother's Name GUL Spouse Name Any Identification mark(s) preferably visible BLUK HEIR Present nationality AFGHANISTAN Manner of acquiring present nationality Birth Date of acquiring present nationality 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 Paste your Recent passport size photograph here

    Height (in cm) 4 Day(s)

    0 1

    Previous nationality

    AFGHANISTAN

    Whether person of Indian Origin


    Address City LOGER LOGER

    NO

    Address of last residence (Outside India)


    Country AFGHANISTAN

    Address intended for longer stay in India (Registration)


    Address 111 HAUZ RANI City/District DELHI Pin Code 110017 Phone Number State Mobile Number DELHI

    Any Other Address in India


    Address City/District Pin Code Phone Number State Mobile Number

    Email/Occupation/Profession Details
    E-Mail Id Profession/Occupation BUSINESS

    Passport Details
    Passport No. Date of Issue OR139622 25/01/2007 Place of Issue Expiry Date AFGHANISTAN, LOGER 07/05/2016

    Visa Details
    Visa Number AP4776643 Date of Issue 13/09/2012 Valid For Single Entry Special endorsement, if any Place of Issue Expiry Date Visa Type AFGHANISTAN, KABUL 12/12/2012 MEDICAL VISA

    Page 1 of 3

    190912LVIEAC Application ID No. 190912LVIEAC Appointment Date 20/09/2012

    Organization/Company/Institute/Hospital Details
    Name MAX Address SAKET State DELHI Telephone Number

    City Email ID

    DELHI

    Arrival Details
    Place of embarkation/boarding for India KABUL,KABUL,AFGHANISTAN Date of arrival in India 14/09/2012 Place of disembarkation/arrival in India DELHI Mode of Journey Air Flight /Ship /Bus /Train No. Purpose of visit to India Medical Treatement of self

    Previous Registration Details in India


    Registration Number Name Name Address City Phone Number Place of Registration Nationality Relationship Country Visa Type Duration From Passport Number To

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


    Relationship

    Person to be contacted in Case of Emergency

    Category

    Others

    Military service details


    Organisation Rank Country of Last Posting Designation Place of Last Posting

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

    Page 2 of 3

    190912LVIEAC Application ID No. 190912LVIEAC Appointment Date 20/09/2012

    Instruction
    Document required for Registration
    1. 2. 3. 4. 5. Registration form in triplicate. 04 (for adult) and 02 (for minor) recent passport size photographs Copy of passport (photo page, Page indicating validity, page bearing arrival stamp), Copy of Indian Visa and copies of medical papers and test reports. Proof of residential address in India. Copy of valid notarized Lease/Rent agreement or copy of C-form from the Hotel and copy of recent electricity/telephone bills alongwith letter from the landlord. Letter from concerned hospital where treatment is being taken alongwith supportive medical documents/diagnostic test report with tentative period of treatment. Letter from concerned hospital where treatment is being taken alongwith supportive medical documents/diagnostic test report with tentative period of treatment.

    Registration office address


    Office Name Address City State Pin Code Phone Number : : : : : : FRRO - NEW DELHI EAST BLOCK 8, SECTOR 1 , R.K. PURAM, NEW DELHI DELHI DELHI 0 01126711443

    Office opening time: Applications are accepted upto

    closing time:

    Page 3 of 3

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