HIGH COMMISSION OF INDIA

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DHAKA(BANGLADESH)

Visa Application Form

Signature

BGDDY526A016

Previous/other Name if any

Sex

Application Id :BGDDY526A016

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

Marital Status
Religion
Country of Birth
Educational Qualification

MARRIED
HINDU
BANGLADESH
MATRICULATION

Nationality by Birth/ Naturalization

BY BIRTH

Date of issue ( dd/mm/yyyy )

05-MAY-2014
04-MAY-2019

Any Other Previous/Past Nationality

B. Passport Details

BB0080052
DHAKA

Passport No.
Place of issue

Date of expiry (dd/mm/yyyy)

Any other Passport/Identity Certificate held (if yes ,please fill in the following) YES
Country of issue

Web Registration Date : 11-SEP-2016

MALE
11-AUG-1948
KHULNA
4792106084665
NIL
BANGLADESH

Passport/IC No
Nationality/status

BANGLADESH
Y0377236
BANGLADESH

Place of issue
Date of issue(dd/mm/yyyy)

KHULNA
11-SEP-2008

C. Applicants Contact Details

Present
address

PABLA KUNDU PARA, KESHOBLAL ROAD

DAULATPUR, DAULATPUR
KHULNA, BANGLADESH 9202

Phone No
Mobile /Cell No

01725895343
1911754836

Email address

Permanent PABLA KUNDU PARA, KESHOBLAL ROAD

Address
DAULATPUR, DAULATPUR
KHULNA
D. Family Details
Relation

Name

Nationality

Prev. Nationality

Place/Country of Birth

Fathers

GANENDRA NATH SHEEL

BANGLADESH

BANGLADESH

KHULNA
BANGLADESH

Mothers

NERUPAMA SHEEL

BANGLADESH

BANGLADESH

KHULNA
BANGLADESH

Spouse

SHADHONA SHEEL

BANGLADESH

BANGLADESH

KHULNA
BANGLADESH

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) 12 Month
BY AIR/ HARIDASPUR

Type Of Visa Required

Period of Visa
Port Of Arrival

NONI GOPAL SHEEL

No of Entries
Expected Date of Journey
Port of Exit

MULTIPLE
30-OCT-2016
BY AIR/ HARIDASPUR

Appointment Date : 20-SEP-2016 At : 9.45

A. Personal Particulars (As in Passport)

Surname (As in Passport)
SHEEL
Given Nam e (As in Passport) NONI GOPAL

Required Detail of

TOURIST VISA
KOLKATA

Purpose of Visit : TOURISM

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

YES

ASHOK KUMAR SHEEL

PATHARGHATA , RAJARHAT, NORTH 24 PGS, WB.

Application Id :BGDDY526A016

Places to be Visited

Cities in India Visited KOLKATA

Type of Visa TOURIST VISA
Visa Number
VJ7875535
Visa Issued Place DHAKA
Date of Issue
01-SEP-2015
Countries visited in last 10 years
INDIA
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
TEACHER
Employer name/business NONI GOPAL SHEEL
Employer Address DAULATPUR, KHULNA
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

State
1 PATHARGHATA RAJARHAT NORTH 24 PARGANAS WEST BENGAL. 00919775644312,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India
In BANGLADESH
SHADHONA SHEEL
Nam e ASHOK KUMAR SHEEL
Address PATHARGHATA , RAJARHAT
PABLA KUNDU PARA, DAULATPUR
NORTH 24 PGS, WB.

Phone
00919775644312
Number

Phone No.

KHULNA
01725895343

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.

11-SEP-2016
Date :.

..
Applicants signature (as in Passport)