GOVT OF INDIA

Embassy of India, Doha (Qatar)

Visa Application Form for Bangladeshi Nationals

(Other than Diplomatic / Official)

1. Full name (BLOCK LETTERS) Mr. / Mrs. / Miss :
2. Place of birth:
3. Educational qualifications:
4. Occupation:
5. Nationality:
6. a) Permanent Address :
:
(b) Present Address:
:
(c) Telephone(Res.)
Mobile:
7. Name, address and nationality of Father / Spouse :
 
8. (i) Whether the following migrated to areas now constituting Bangladesh on or after 1.3.1947 (If not applicable denote N. A.)
(a) Applicant:
(b) Applicant’s Father/ Spouse
(ii) If so, (If not applicable denote N. A.)
(a) Approximate date of migration:
(b) Address in India before migration:
9. Children accompanying the applicant, if any:
S.Nos. Name Sex (M / F) Date Place of Birth
1.
2.
3.
10. Particulars of passport:
(a) Passport No.: Date: place of issue
(b) Date of expiry:
(c) If possessing international Passport:
(d) whether it has been endorsed valid for India :
11. Whether previously in India and if so, place of residence with date:
Date of visit:
Address:
12. Whether permission to visit India or to extend stay in India has been refused previously, Yes  No.
and if so, when and by whom ?
13. (i) Purpose for which visa required now :
(ii) Period for which visa required:
(iii) Proposed date of departure:
(iv) Proposed date of return:
14. If traveling by land route, specify the Indian checkpost through which entry and exit desired:
15. Places / Persons proposed to be visited with full address:
Name of the persons / places:
Address in full:
Telephone no. : Mobile:
16. Whether transit visa / short-term single entry / long-term multiple entry visa required:(YES/NO)
17. For Transit visa only ( Applicable or Not Applicable )  
(i) Country of final destination:
(ii) (a) Is passport valid for that country ?
(b) Has visa / immigration permit of that country been obtained ?
18. For Student only ( Applicable or Not Applicable )  
Name and address of the institution in India in which admission has been secured (attach attested copy of admission certificate or other relevant document)
Name :
Address:
:
19. Names, addresses and contact numbers of two persons in India
and in Bangladesh to whom applicant is well known:
In India :
1.Name
address
contact number
2.Name
address
contact number
In Bangladesh :  
1. Name
address
contact number
2. Name
address
contact number
20. How are the expenses proposed to be met for stay in India:
(State foreign exchange authorized)
21. If not carrying foreign exchange, furnish:Sponsorship certificate in prescribed form
22. (i) Do you belong / have you previously belonged to military / semi-military, Police / semi-police organization? : YES NO
(ii) If the answer is YES, please give details:
I enclosecopies of this application along withcopies of my recent photograph.
I hereby certify that the information furnished above is correct and further undertake that I shall utilize my visit to India for purpose for which the visa has been applied for and shall not on arrival in India, try to obtain employment or set up business or to extend my stay for any other purpose.
Date:
P.O. Box No.
Tel No. (Office)
(Residence)
(Mobile)