1. Name in full 　　

    2. Profession (designation and rank) 　　

    3. Full postal address (should include House No., Street, 　　District/Town, County, Province) 　　

    A. Office/Work Unit 　　

    B. Residence 　　

    4. (A) Father name （in full） 　　

    Present Occupation and Address 　　

    (B) Name of Spouse (in full) 　　

    Nationality Occupation 　　

    Office Address 　　

    5. Date & Place of birth 　　

    6. Visa applied for 　　

     Purpose 　　

    Duration 　　

    Full name of host organization 　　

    (Please attach letter of invitation. Give full name of concemed company if going on business etc.) 　　

    Commencing from/period of visit 　　

    7. Places intended to be visited 　　

    8. Places of intended entry into/exit from India 　　

    9. Children, of any, accompanying the applicant name 　　

    I) 　　

    II) 　　

    III) 　　

    10. Details of Passport (s) held: 　　

     Number of Passports 　　

     Category 　　

     Issued by 　　

     Place of Issue 　　

    Date of Issue 　　

    11. Has permission to visit of to extend stay in India previously been refused, if so when and by whom 　　

    12. Details of last visit 　　

    Date and Place from where visa issued 　　

    13. For TRANSIT VISA only 　　

     Place of final destination 　　

     Is passport valid for that country? 　　

    Has visa/immigration permit of that country been obtained? 　　

    Full address of place of place of stay in India 　　

    14.I, hereby declare that all the statements and information given 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 to visit India under any other name, surname, maiden name, etc., and that the passport held by me at present as indicated in column 10 is the only passport that I hold. I realize that should any of the above statement be found to be false, untrue or incorrect, my visa will be liable to cancellation by the competent authority and I will be liable to such other penalties as may be prescribed. 　　

    Date 　　

    Place Signature of applicant 　　

    NOTE 　　

    1. Application form is to be filled in triplicate by each applicant. 　　

    2. Three recent passport size photographs to be attached with application in addition to one photograph pasted on the form. 　　

    3. All columns should be filled giving complete and detailed information.

    Incorrectly filled or incomplete forms would result in delay in processing. 　　

    4. If information furnished is found to be incorrect, visa is likely to be refused or cancelled.