APPENDIX XXXVIII

(Para 18.1(4))

GOVERNMENT OF INDIA
MINISTRY OF HOME AFFAIRS

(a) REQUEST FOR SPECIAL PERMIT (FOR PROTECTED AREAS)

(Application to be submitted in duplicate)

1. Name of applicant (Mr./Mrs./Ms.)__________________________________________________

(in capital letters with surname underlined)

Photograph

2. Father’s / Mother’s name ________________________________________________________

3. Father’s / Mother’s nationality _____________________________________________

4. Surname at birth; if different ______________________________________________

5. Place & Date of Birth (Name of Town & Country) ______________________________

6. Nationality:

(a) Present_____________________________________________________________

(b) Past, if different & till which date________________________________________

(c) Reason for change____________________________________________________

7. Occupation____________________________________________________________

8. Permanent address______________________________________________________

9. Mailing address of India, if any____________________________________________

______________________________________________________________________________

10. Reference:

(a) In country of applicant________________________________________________

(b) India_____________________________________________________________________
1. Passport details:

(a) Number____________________________________________________________

(b) Issued by________________________________________________________

(c) At____________________________________________________________

(d) Valid up to ____________________________________________________

2. Details of visa for India, if any obtained:

(a) Issued by __________________________________________________________

(b) Number _________________________________________________________

(c) At____________________________________________________________

(d) Valid up to __________________________________________________________

3. Places proposed to be visited______________________________________________

4. Route intended to be followed_____________________________________________

5. Purpose of visit________________________________________________________

16. Likely date of visit____________________________________________________

17. Likely duration of visit________________________________________________

18. Is any one accompanying the applicant? _________________________________

If so, please give details_________________________________________________

19. Arrangement for travel and accommodation

That may have been made_______________________________________________

_______________________________________________________________________

20. Details of previous visit to India__________________________________________

21. Whether previously visited any restricted/

Protected area in India? __________________________________________________

If so, please give detail of the places

Visited and the date of visit ______________________________________________

22. Has any earlier request for permits been refused? ____________________________

If so, please furnish details________________________________________________

 DECLARATION

The Information given above is correct and complete to the best of my knowledge.

Place_______________________________

Date________________________________ (Signature of Applicant)

Note:-1. This applicant is to be sent to the Ministry of Home Affairs,

New Delhi.

2. It is advisable to make the application at least eight weeks

ahead of the date of the proposed visit.

3. Applicants outside India are expected to route their

application though the nearest Indian Diplomatic or Consular
Mission.