EMBASSY OF INDIA MEXICO CITY

Musset 325, Colonia Polanco,Delegacion

Miguel Hidalgo, C.P.11550, Mexico D.F.

Paste your unsigned

recent color photograph.
Size: 2 X 2

www.indembassy.org
52-55-5531-1050

Visa Application Form

Signature

MEXMV0262314

Web Registration Date : 06-AUG-2014

Web File Number :MEXMV0262314

Previous/other Name if any

Sex
Date of birth
Place of Birth Town/City
Citizenship /National ID No
Visible identification marks
Current Nationality

Male
18-JAN-1986
LEON GUANAJUATO
NA
NO
MEXICO

Marital Status
Religion
Country of Birth
Educational Qualification

Single
CATILIC
MEXICO
HIGHER SECONDARY

Nationality by Birth/ Naturalization

BY BIRTH

Date of issue ( dd/mm/yyyy )

31-JAN-2013
31-JAN-2016

Any Other Previous/Past Nationality

B. Passport Details

G11304197
LEON GUANAJUATO

Passport No.
Place of issue

Date of expiry (dd/mm/yyyy)

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)

Nationality/status
C. Applicants Contact Details
Present
address

BAJIO 208
LEON GUANAJUATO
LEON GUANAJUATO, MEXICO 37510

Phone No

477 7118725

0453316203233
Email address carubens86@hotmail.com

Mobile /Cell No

Permanent BAJIO 208

Address
LEON GUANAJUATO
LEON GUANAJUATO
D. Family Details
Relation

Name

Nationality

Prev. Nationality

Place/Country of Birth

Fathers

RUBEN ELIAS LOPEZ

MEXICO

MEXICO

SILAO GUANAJUATO
MEXICO

Mothers

MARIA CARMEN CERRILLO SALAZAR

MEXICO

MEXICO

JALISCO
MEXICO

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)

TOURIST VISA
(Month) 6 Month
NEW DALHI

Type Of Visa Required

Period of Visa
Port Of Arrival

RUBEN ERNESTO ELIAS CERRILLO

No of Entries
Expected Date of Journey
Port of Exit

Multiple
18-AUG-2014
NEW DALHI

Appointment Date : 11-AUG-2014 At : 11.30

A. Personal Particulars (As in Passport)

Surname (As in Passport)
ELIAS CERRILLO
Given Nam e (As in Passport) RUBEN ERNESTO

Required Detail of

TOURIST VISA
TAG MAHAL END
LUDHIANA

Purpose of Visit : TOURISM

F. Previous Visit Details
Have You Ever visited India ?
Address where You stayed in
India

NO

Web File Number :MEXMV0262314

Places to be Visited

Cities in India Visited

Type of Visa
Visa Number
Visa Issued Place
Date of Issue
Countries visited in last 10 years
BELICE
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 WORKER
Designation/Rank
EMPLOY
Employer name/business RESTAURANT LA FRONTERA
Employer Address HILARIO MEDINA 511
Phone Number
477 7631921

Past occupation if any OTHERS

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

I. Details of Two Reference

In India
Nam e NIRMAL GREWALL
Address V P O LALTON KALAN

DUSTY-LUDHIANA ON AUG 5

Phone
919915557610
Number

In

State

Phone No.

MEXICO

CLAUDIA ALEJANDRA MUNOS PATLAN

BAJIO 214 PARQUE MANZANARES

0444771288403

J. DECLARATION:
a.
b.
c.
d.

I do not hold any other passport(s) other than those detailed above.
I have read and understood all the conditions for the visit to India and I am willing and able to abide fully by them.
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.
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.

06-AUG-2014
Date :.

..
Applicants signature (as in Passport)