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Signature
BGDR70040515
Application Id :BGDR70040515
Date of birth
Place of Birth Town/City
Citizenship /National ID No
Visible identification marks
Current Nationality
Male
05-DEC-1974
CHANDPUR
1319585756400
NIL
BANGLADESH
Marital Status
Religion
Country of Birth
Educational Qualification
Married
HINDU
BANGLADESH
MATRICULATION
BY BIRTH
23-MAR-2008
22-MAR-2018
B1456562
CHANDPUR
Passport No.
Place of issue
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
Phone No
Mobile /Cell No
01725712377
Email address
Permanent VILL:SUCHIPARA,P.O:SUCHIPARA
Address
P.S:SHAHRASTI
CHANDPUR
D. Family Details
Relation
Name
Nationality
Prev. Nationality
Place/Country of Birth
Fathers
BANGLADESH
BANGLADESH
CHANDPUR
BANGLADESH
Mothers
BANGLADESH
BANGLADESH
CHANDPUR
BANGLADESH
Spouse
BANGLADESH
BANGLADESH
A
BANGLADESH
(Visa shall be valid from the Date of Issue and not from the Date of Journey)
TOURIST VISA
(Month) 12 Month
No of Entries
Expected Date of Journey
Port of Exit
Multiple
31-AUG-2015
BY RAIL GEDE/BYROAD HARIDASPUR
Required Detail of
TOURIST VISA
KOLKATA
WEST BENGAL
NO
Application Id :BGDR70040515
Places to be Visited
Visa Number
Date of Issue
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 PRIVATE SERVICE
Designation/Rank
Employer name/business SREE KRISHNO KANTA SARKER
Employer Address KACHUA MAIN ROAD,MODDOBAZAR,KACHUA,CHANDPUR
Phone Number
01727297980
Phone
+91 33 22280920
Number
In
SREE REKHA RANI SHEL
State
Phone No.
BANGLADESH
SHAHRASTI,CHANDPUR
01725712377
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.
26-JUL-2015
Date :.
..
Applicants signature (as in Passport)