Granted Visa No. __________________Dated __________________alid for single journey to India within __________________days.
Valid for stay at places specified below.

	Place	District	State
(i)	__________________	__________________	__________________
(ii)	__________________	__________________	__________________
(iii)	__________________	__________________	__________________

Check post of : (i) Entry into India : Attari /Bombay /Delhi

ii) Entry into India : Attari /Bombay /Delhi

Holder accompanied by __________________children.

TO BE COMPLETED BY THE APPLICANT

VISA NON-EXTENDABLE

1. Name in full (in block letters) Mr. / Mrs. / Miss :

2. Address (House No / Village / City / Thana / Dist. / Province):

(i) Present(House No / Village):

(City / Thana):

(Dist. / Province):

(ii) Permanent(House No / Village):

(City / Thana):

(Dist. / Province):

3. Father’s/ Spouse’s Name (in full):

Nationality:

Occupation:

Address:

:

4. Date of Birth:

5. Place of Birth:

6. Religion:

7. Nationality:

8. (i) Distinguishing Marks:

(as described in the Passport)

(ii) Colour of (a) Eyes:(b) Hair:

(iii) Height: MetersCms

9. (i) Present occupation in detail (with designation, rank, department, name of employer or if in Business, the nature of business):

(ii) Past Occupation:

10. Duration and Date of Commencement of visa applied for

11. Place of visit / stay (or break of journey in case of transit visa) desired:

SI.No.	Name	Father’s/ Spouse’s Name	House No./ Street	Village /Town	Police /Station	Dist. /State	Whether Place is in Cantt. Area? Say (Yes/No)
1.							Yes /No
2.							Yes /No
3.							Yes /No

Note: In the vertical column No. 1 the applicant should mention only that place which he / she would visit first in India. No request for change of this place will be entertained at later stage

12. Check post of :

(i) Entry into India : Attari /Bombay /Delhi

(ii) Exit from India:Attari /Bombay /Delhi

(Please see instruction no.4)

13. Children accompanying the applicant, if any:

SI.No.	Name	Sex	Date of Birth
1.
2.
3.

14. Name, Parentage ,detailed address with contact numbers of at least two persons in India to whom the applicant is known:

i) Name:

Referee’s Parentage:

Address:

ii) Name:

Referee’s Parentage:

Address:

15. (a) International / Special Pakistan passport held ( Applicable or Not Applicable ) :

No.: issued at on

with endorsement for journey to India valid unto

(b) Details of any other passport(s) previously held, and if so, whether passport(s) renewed/ lost, etc. ( Applicable or Not Applicable )

No.:

Date of Issue:

(c) Any other foreign passport / Identity Card held ( YES / NO )

Country of Issue:

Passport(s) No.:

Date: / Place of Issue: Nationality / Status described therein:

16. Object of visit (Give detailed information including documentary evidence)

17. Has permission to visit or to extend stay in India previously been refused? Yes / No. If so, when and by whom?

(Mention control No. and date also)

18. Details of last visit: Category, number, date and office of issue of visas previously held, if any:

19. Details of previous pending application or unavailed of Visa, if any (with control no. and date):

20. For Transit Visas only ( Applicable or Not Applicable )

(i) Place of final destination:

(ii) Is passport valid for country of destination?

(iii) Has visa / immigration permit of that country been obtained?

(iv) If so, its No.: date: place of issue:

(v) The address and contact number of stay in India:

21. If you have migrated from India to Pakistan on or after 1st March 1947, please state: (Answer Yesor No)

(i) Approximate date of migration:

(ii) Address in India before migration:

22. Do you belong / have you previously belonged to military / semi-military / police / semi-police organization?

(Answer Yesor No)

(If the answer is Yes, please give details):

23. I hereby declare that all the statements and information given above by me in this application are true to the best of my knowledge and belief. I also declare that I have not submitted any application for visa for India under any other name, surname, maiden name, etc. and that the passport held by me at present as indicated in column 15 is the only passport held by me at present. I realize that should any of the above statements be found to be false, untrue or incorrect, my visa will be liable to cancellation by any competent authority and I will be liable to such other penalties as may be prescribed.

Place:

Date:

Tel No.