GOVT OF INDIA

EMBASSY OF INDIA, DOHA (Qatar)

VISA APPLICATION FORM

Part 'A'

(TO BE FILLED IN DUPLICATE BY ALL APPLICANTS)

PLEASE AFFIX

ONE PASSPORT

PHOTOGRAPH

HERE

1. (a) Full name Mr. / Mrs. / Miss :
(b) Previous Name, if any:
2. (a) Present Nationality :
(b) Any other nationality:
Present or previous

3. (a) Father’s Name

Nationality
(b) Spouse’s Name (If Not Applicable Denote 'NIL')
4. Place of Birth:
(In BLOCK Letters)
City State / Province Country
5. Date of Birth:
6. Address :
Phone No. :
Mobile No.:
7. Profession (Details of Present employment)*
* Please indicate name of the Organization where employed along with the post held.
8. Passport No.: Date of issue: Issued by:
Place of Issue: Expiring on:
9. Children included in the applicant’s passport: (To be filled only when children are accompanying the applicant)
name Place Date of Birth Sex Relationship Identification
mark, if any
10. Whether visa has been refused previously?
Yes  No. If ‘Yes’, give details:
11. Details of previous visits to India, if any:
12.(a) Period for which visa is required:
(b) No. of entries:
(1) Single  (2) Double  (3) Triple / Multiple
13. Countries from which entry into India will be made:
14. Purpose of Journey
(1) Transit (2) Tourist (3) Business
(4) Education (5) any other (specify):
15. Place(s) in India to be visited :
16(a) Approximate Date of Arrival in India :
(b) Approximate Date of Departure from India
17. (a) Port of first entry into India :
(b) Port of final departure from India:
18*. Declaration to be made by applicants seeking to stay in India for more than one year:
"I hereby undertake that I shall subject myself to a medical test including for AIDS within one month of arrival in India. In case I am found positive for AIDS, I will leave India".

PART ‘B’

(TO BE FILLED IN BY ALL APPLICANTS)
1. Whether holding valid “No objection to return to India” endorsement and if so, give particulars : Yes  No. if so, give particulars :
2.Name, address and contact number of two references :
(A) In the country of Applicant: i) Name
i) Address
i) Contact No
ii) Name
ii) Address
ii) Contact No
(B) In India i) Name
i) Address
i) Contact No
ii) Name
ii) Address
ii) Contact No
Date: