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DHAKA(BANGLADESH)

Visa Application Form

Signature

BGDDYC7D4716

A. Personal Particulars (As in Passport)

Surname (As in Passport)
BISWAS
Given Nam e (As in Passport) SUDHENDU
Previous/other Name if any

Web Registration Date : 16-OCT-2016

Application Id :BGDDYC7D4716

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

MALE
01-JAN-1950
KHULNA
4711271089302
NIL
BANGLADESH

Marital Status
Religion
Country of Birth
Educational Qualification

MARRIED
HINDU
BANGLADESH
BELOW MATRICULATION

Nationality by Birth/ Naturalization

BY BIRTH

Date of issue ( dd/mm/yyyy )

06-OCT-2016
05-OCT-2021

Any Other Previous/Past Nationality

B. Passport Details

BM0036971
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) NO
Country of issue

Place of issue

Passport/IC No

Date of issue(dd/mm/yyyy)

Nationality/status
C. Applicants Contact Details
Present
address

TATULTALA
JOLMA,BATIAGHATA
KHULNA, BANGLADESH 9260

Phone No
Mobile /Cell No

1711157000

Email address

Permanent TATULTALA
Address
JOLMA,BATIAGHATA
KHULNA
D. Family Details
Relation

Name

Nationality

Prev. Nationality

Place/Country of Birth

Fathers

RASHIKLAL BISWAS

BANGLADESH

BANGLADESH

KHULNA,
BANGLADESH

Mothers

PROBASHI BISWAS

BANGLADESH

BANGLADESH

KHULNA,
BANGLADESH

Spouse

BISHAKA BISWAS

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) 60 Month
BY ROAD HARIDASPUR

Type Of Visa Required

Period of Visa
Port Of Arrival

SUDHENDU BISWAS

No of Entries
Expected Date of Journey
Port of Exit

MULTIPLE
30-OCT-2016
BY ROAD HARIDASPUR

Required Detail of

TOURIST VISA
BARASAT NABAPALLY,KOLKATA-124
N 24 PGS,WB

Purpose of Visit : MEETING FRIENDS/RELATIVES

F. Previous Visit Details
Have You Ever visited India ? YES
Address where You stayed in BARASAT NABAPALLY,KOLKATA-124
India

N 24 PGS,WB,,

Cities in India Visited KOLKATA

Type of Visa TOURIST VISA
Visa Issued Place DHAKA
Countries visited in last 10 years

VK1795400

Visa Number
Date of Issue

03-MAR-2016

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 FARMER
Designation/Rank
Employer name/business WORK IN OWN LAND
Employer Address TATULTALA,JOLMA,BATIAGHATA,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
Phone No.
1 PROKASH CHANDRA ROY BARASAT NABAPALLY,KOLKATA-124 NORTH 24 PARGANAS WEST BENGAL. 0091-9837542365,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India
In BANGLADESH
PABITRA KUMAR BISWAS
Nam e PROKASH CHANDRA ROY
Address BARASAT NABAPALLY,KOLKATA-124
TATULTALA,JOLMA
N 24 PGS,WB

Phone
0091-9837542365
Number

,BATIAGHATA,KHULNA
01711-157000

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.

16-OCT-2016
Date :.

..
Applicants signature (as in Passport)

Application Id :BGDDYC7D4716

Places to be Visited