PROFORMA

(MoP&NG/ONGC/DGH)
(Foreign Nationals Including Crew)

1. Name of the Foreigner (in capital letters with : PLEASE FILL UP

surname underlined)
2. Fathers name : PLEASE FILL UP
3. Place / Country and Date of Birth : PLEASE FILL UP
4. Nationality 1) Present : PLEASE FILL UP
2) Past : Nil
5. Occupation (Address of employer, if : PLEASE FILL UP
employed) : LANPAN PTE LTD
2 Venture Drive, #12-08 Vision Exchange,
Singapore 608526

6. Present Address : L&T Hydrocarbon Engineering LTD, 7 th Floor, B Wing,

Gate No. 1, Powai Campus (W), Saki Vihar
Road, Powai, Mumbai 72, India

7. Permanent Address : PLEASE FILL UP

8. Reference
a) In country of applicant : VALENTINE MARITIME GULF LLC
P.O.BOX: 45877, ABU DHABI, UAE

b) In India : Mr. Ashish Shukla Joint General Manager, +91-

9819645176, L&T Hydrocarbon Engineering
LTD, 7th Floor, B Wing, Gate No. 1, Powai
Campus (W), Saki Vihar Road, Powai,
Mumbai 72, India

9. Passport details a) Number : PLEASE FILL UP

b) Issued at (Place) : PLEASE FILL UP
c) Date of Issue : PLEASE FILL UP
d) Valid upto : PLEASE FILL UP

10. Details of visa for India, if obtained : To Be applied

No. : Issued by : N/a
At : Valid Until : N/a

11. Places proposed to be visited : ONGC Offshore field- Transporation & Installation -
Daman Development and Pipeline Replacement
Projecr -4(PRP-4)

12. Purpose of visit : Transportation and Installation- Daman Development

Project Pipeline Replacement Projecr -4(PRP-4)

13. Port of Entry into India : Mumbai /Gujarat Port

14. Likely date of visit : 01/01/2018

15. Duration of visit : 6 Months

16. Details of previous visits to India, if any : N/a

17. Has he / she / they previously visited any : N/a

restricted area or protected area in India?
If so details there of

18. Has any earlier request for the permit/Visa : No

Been refused? If so, details there of

The information given above is correct to and complete to the best of my knowledge.
Dated: 16/11/17

Place: ABU DHABI Signature of applicant