HIGH COMMISSION OF INDIA

DHAKA(BANGLADESH) Paste your unsigned

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Visa Application Form

Signature
BGDDXD263317

A. Personal Particulars (As in Passport)

Appointment Date : 19-DEC-2017 At : 9.45 Hrs.

Surname (As in Passport) BISWAS
Given Name (As in Passport) ANJANA
Previous/other Name if any
Sex FEMALE Marital Status MARRIED
Date of birth 10-MAR-1972 Religion HINDU
Application Id :BGDDXD263317

Place of Birth Town/City KHULNA Country of Birth BANGLADESH

Citizenship /National ID No 4795121381859 Educational Qualification BELOW MATRICULATION
Visible identification marks NILL
Current Nationality BANGLADESH Nationality by Birth/ Naturalization BY BIRTH
Any Other Previous/Past Nationality
B. Passport Details
Passport No. BA0422446 Date of issue ( dd/mm/yyyy ) 16-FEB-2014
Place of issue DHAKA Date of expiry (dd/mm/yyyy) 15-FEB-2019
Any other Passport/Identity Certificate held (if yes ,please fill in the following) YES
Country of issue BANGLADESH Place of issue KHULNA
Passport/IC No Y0093108 Date of issue(dd/mm/yyyy) 23-SEP-2007
Web Registration Date : 11-DEC-2017

Nationality/status BANGLADESH

Khulna
C. Applicants Contact Details

14, SIR IQBAL ROAD Phone No 1711404881

Present
address P. O. KHULNA SADAR - 9100 Mobile /Cell No 1711404881
P. S. KHULNA SADAR, DT. KHULNA, BANGLADESH 9100 Email address

Permanent 14 NO SHIBSHA, 4 NO SIR IQBAL ROAD

Address P. O. KHULNA SADAR - 9100
P. S. KHULNA SADAR, DT. KHULNA

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
GOPALGANJ
Fathers MONINDRA LAL HAZRA BANGLADESH BANGLADESH BANGLADESH
GOPALGANJ
Mothers RANI BALA HAZRA BANGLADESH BANGLADESH BANGLADESH
KHULNA
Spouse DILIP BISWAS BANGLADESH BANGLADESH BANGLADESH
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO
E. Details of Visa Sought (Visa shall be valid from the Date of Issue and not from the Date of Journey)

Type Of Visa Required TOURIST VISA No of Entries MULTIPLE

Period of Visa ( Month) 12 Month Expected Date of Journey 27-DEC-2017
Port Of Arrival BY ROAD HARIDASPUR Port of Exit BY ROAD HARIDASPUR

ANJANA BISWAS
 Required Detail of TOURIST VISA
Places to be Visited KOLKATA. W. B.

Purpose of Visit : TOURISM

F. Previous Visit Details
Have You Ever visited India ?
Address where You stayed in
India
YES
1, CHANDRA MOHAN SUR LANE
P. S. BIDHAN NAGAR, KOL - 67. W. B.

Application Id :BGDDXD263317
Cities in India Visited KOLKATA
Type of Visa TOURIST VISA Visa Number VK3487254
Visa Issued Place DHAKA Date of Issue 17-AUG-2016
Countries visited in last 10 years
INDIA
Have you been refused an Indian Visa or extension of the same previously or deported from India ?
If yes above mention when and by whom with control
No/Date
G. Profession/Occupation Details of Spouse
Present Occupation HOUSE WIFE Designation/Rank PROPRIETOR
Employer name/business MASERS RANAJIT BISWAS AND SONS
Employer Address 15/1 HELATALA ROAD KHULNA
Phone Number
01711404881
Past occupation if any
Are/have you worked with Armed forces/ Police/ Para Military forces ? NO
Organization Designation
Place of Posting Rank
H. Address of Place of Stay / Hotel
Place/Hotel Name Address of Place / Hotel State Phone No.
1 DK INTERNATIONAL HOTEL 11/1A MARQUSE STREET KOLKATA WEST BENGAL. 22556282,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India In BANGLADESH
Nam e RIMA BISWAS ASHIT BISWAS
Address 1, CHANDRA MOHAN SUR LANE 14, SIR IQBAL ROAD
P.S. BIDHAN NAGAR,DT. KOL-67. W. B. P. S. KHULNA SADAR, DT. KHULNA
Phone
9836943921 01711298280
Number

J. DECLARATION:

a. I do not hold any other passport(s) other than those detailed above.
b. I have read and understood all the conditions for the visit to India and I am willing and able to abide fully by them.
c. I declare that the information given in the form is complete and correct and the visit to India will be undertaken for the
purpose indicated in the application.
d. I understand that in case the information provided in the form is found to be incorrect, I will be liable for denial of visit/ entry
or deportation and/ or other penalties during the visit as provided by Indian law.

..
11-DEC-2017
Date :. Applicants signature (as in Passport)