Visa Application Form

A. Personal Parti cul ars (As in Passport)

Surname (As in Passport)
Given Name (As in Passport)
Previous/other Name if any
Sex Marital Status
Date of birth Religion
Place of Birth Town/City Country of Birth
Citizenship /National ID No Educational Qualification
Visible identification marks
Current Nationality Nationality by Birth/ Naturalization
Any Other Previous/Past Nationality
B. Passport Detai l s
Passport No. Date of issue ( dd/mm/yyyy )
Place of issue Date of expiry (dd/mm/yyyy)
Any other Passport/Identi ty Certi fi cate hel d (i f yes ,pl ease fi ll i n the foll owing)
Country of issue Place of issue
Passport/IC No Date of issue(dd/mm/yyyy)
Nationality/status
C. Appl icant s Contact Detail s
Phone No
Mobile /Cell No

Present
address

Email address

Permanent
Address

D. Famil y Detail s

Rel ati on Name Nati onali ty Prev. Nat ional ity Pl ace/Country of Birth
Fathers
Mothers
Spouse
Were your Grandfather/Grandmother(Paternal/Maternal ) Paki stan Nati onals Or bel ong to Paki stan hel d area :
E. Detail s of Vi sa Sought (Visa shall be valid from the Date of Issue and not from the Date of J ourney)
Type Of Visa Required No of Entries
Period of Visa Expected Date of J ourney
Port Of Arrival Port of Exit


Paste your unsigned
recent color photograph.
Size: 2 X 2


Signature
LKAK01004114
SAEED RAMLAN MOHIDEEN ALI
COLOMBO
SRI LANKA
SRI LANKA
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MAWANELLA
SAEED RAMLAN
SRI LANKA
0776373263
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17-JUN-2008
17-JUN-2018
ramalan67@yahoo.com
3 Month
MOHIDEEN ALI
Kandy
BY BIRTH
N/A
KEGALLE
NAWALAPITIYA
SRI LANKA
ALL PORT
35/15, RAHMANIYA MAWATHA, MAHAWATTA
MAWANELLA.
SABARAGAMUWA
01-MAY-1988
SRI LANKA
31, Rajapihilla Mawatha
Single
MOHIDEEN ALI
Male
881221853V
SRI LANKA
N2084982
Un-Married
NO
www.ahcikandy.org
NO
(Month)
SITHY ZAHIRA
Assitant High Commission of India
19-JUN-2014
TOURIST VISA
HIGHER SECONDARY
MAWANELLA.
ISLAM
35/15, RAHMANIYA MAWATHA, MAHAWATTA
SABARAGAMUWA, SRI LANKA 71500
0094812222652
Required Detail of

Purpose of Visit :
F. Previ ous Vi si t Detail s
Have You Ever visited India ?
Address where You stayed in
India

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. Professi on/Occupati on Detail s
Present Occupation Designation/Rank
Employer name/business
Employer Address
Phone Number

Past occupation if any
Are/have you worked with Armed forces/ Police/ Para Military forces ?
Organization Designation
Place of Posting Rank
H. Address of Place of Stay / Hotel
Place/Hotel Name Address of Place / Hotel State Phone No.

I. Detail s of Two Reference
In Indi a In
Name
Address
Phone
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.




..
Date :. Applicants signature (as in Passport)
M. H. A. HUSEIN
NO
SRI LANKA
QATAR, SINGAPORE, MALAYSIA AND THAILAND
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RAZICK & SONS (PVT) LTD.
BUSINESS PERSON
37/4, NAYAWELA ROAD,
15-JUN-2014
0352247207
MARKETING MANAGER
CHENNAI 600002.
MAIN STREET, GAMPOLA.
#12, STATE BANK STREET, ANNA SALAI,
MAWANELLA.
,
M.A. HAFIZ
9042280003
Places to be Visited
NO
TOURISM
CHENNAI, MADURAI, BANGALORE
TOURIST VISA