Fillable Form
VISA APPLICATION FORM
STAPLE
CONSULATE GENERAL OF INDIA
TWO
CONSULAR WING
PHOTOS
540 ARGUELLO BLVD., SAN FRANCISCO, CA 94118
HERE
TEL: (415) 668-0662/0683 FAX: (415) 668-9764
APPLICATIONS ARE ACCEPTED AT THE COUNTER FROM 9:00am To 12:00pm (MON. to FRI.) ONLY
Note: This application can be used at the Consulate General of India, San Francisco or at any other Consulate
Generals/Embassy of India provided the applicant resides in States of Consulate’s jurisdiction.
PLEASE READ THE INSTRUCTIONS CAREFULLY BEFORE FILLING THE APPLICATION
(PLEASE PRINT IN BLOCK LETTERS ONLY)
FOR OFFICE USE ONLY
1. FULL NAME: ______________________________________________________________________
(First)
(Middle)
(Last)
2. LAST NAME AT BIRTH (IF DIFFERENT):
3. MARITAL STATUS:
Married_________
Unmarried__________
4. DATE OF BIRTH
5. SEX
_______/______/________
Male_______ Female_______
dd
mm
yyyy
6. PLACE OF BIRTH (CITY, STATE & COUNTRY):
7. CURRENT NATIONALITY:
8. ARE YOU A PERMANENT/LONG-TERM RESIDENT IN USA?
Yes _________
No_________
If yes please furnish photocopy of your GREEN-CARD(both sides)/Long-term Visa Status:
________________________________(For Non-US passport holders only)
9. NATIONALITY AT BIRTH:
10. ANY OTHER NATIONALITY HELD AT PRESENT/PAST(
:
Are you in possession of any other passport?)
11. PRESENT ADDRESS:
12. PHONE (HOME):
13. PHONE (WORK):
14. E-Mail:
15. PERMANENT ADDRESS:
16. PROFESSION:
17. EMPLOYER’S NAME AND ADDRESS:
18. PASSPORT NUMBER:
19. VALID UNTIL:
20. ISSUED AT:
21. ISSUE DATE:
22. FATHER’S NAME:
23. NATIONALITY OF FATHER:
24. NAME & NATIONALITY OF SPOUSE:
25. NAME AND NATIONALITY OF MOTHER
26. TYPE OF VISA REQUIRED (check one):
rd
Tourist___| Business___| Student___| Entry___| Journalist__| Conference___| Employment__| Transfer___| Transit___(for short stopover when traveling to a 3
country) |
27. PERIOD OF VISA (check one):
__ Days (for Transit with confirmed onward ticket only), Six Months____ |, One Year____|, Five Years____ | ,
PAGE 1 of 5
Ten Years (for U.S. Citizens only, 6 months each stay)_____ |