Delhi Airport

TOURIST VISA ON ARRIVAL (TVOA)

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Visa Application Form

Signature

I004V276E115

A. Personal Particulars (As in Passport)

Surname (As in Passport)
GONZALEZ
Given Nam e (As in Passport) AURELIANA
Previous/other Name if any
Sex

Web Registration Date : 19-OCT-2015

Application Id :I004V276E115

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

Female
16-JUN-1962
PAMPA DEL INDIO
16217663
NONE
ARGENTINA

Marital Status
Religion
Country of Birth
Educational Qualification

Married
CHRISTIAN
ARGENTINA
HIGHER SECONDARY

Nationality by Birth/ Naturalization

BY BIRTH

Date of issue ( dd/mm/yyyy )

01-AUG-2014
01-AUG-2024

Any Other Previous/Past Nationality

B. Passport Details

AAC100083
ARGENTINA

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

S/CALLE S/N LOTE 17

PAMPA DEL INDIO
CHACO, ARGENTINA 3631

Phone No

540372515433275
Email address nateelpi@gmail.com

Mobile /Cell No

Permanent S/CALLE S/N LOTE 17

Address
PAMPA DEL INDIO
CHACO
D. Family Details
Relation

Name

Nationality

Prev. Nationality

Place/Country of Birth

Fathers

GONZALEZ JIMEME

ARGENTINA

PAMPA DEL INDIO

ARGENTINA

Mothers

SEGUNDO SERVILIANA

ARGENTINA

PAMPA DEL INDIO

ARGENTINA

Spouse

GARCIA MIGUEL

ARGENTINA

PAMPA DEL INDIO

ARGENTINA

Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO

E. Details of Visa Sought
Type Of Visa Required
Period of Visa (Days)
Port Of Arrival

(Visa shall be valid from the Date of Issue and not from the Date of Journey)

TOURIST VISA
34 Days
DELHI AIRPORT

AURELIANA GONZALEZ

No of Entries
Expected Date of Journey
Port of Exit

Single
02-NOV-2015
DELHI AIRPORT

Required Detail of

TOURIST VISA
SHILLONG

Purpose of Visit : TOURISM

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

NO

Application Id :I004V276E115

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
PERU, ITALIA
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 TEACHER
Designation/Rank
Employer name/business COMPLEJO BILINGUE LQATAXAC NAM COMPI
Employer Address CUARTA LEGUA 17 - PAMPA DEL INDIO
Phone Number
Past occupation if any
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 XAVIER SUNN
Address KERIE VILLE, ARBUTHNOTT ROAD

SHILLONG 793003 NORTH EAST INDIA

Phone
+91 9774892439
Number

State

Phone No.

In
LILYAN NORIEGA

SAAVEDRA 280

(3600) FORMOSA - ARGENTINA

+54 3704420945

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.

19-OCT-2015
Date :.

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Applicants signature (as in Passport)