Application Form For Protected Area Permit
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1APPLICATION FORM FOR PROTECTED AREA PERMIT
1.
Name of the Applicant:
(in capital letters with Surname underlined)
........................................................................
2.
Father's Name:
........................................................................
3.
Honorific: Mr./Miss./Mrs.
(score out those not applicable)
........................................................................
4.
Surname at birth, if different:
........................................................................
5.
Birth Place (town and country)
..........................................................................
6.
Date of Birth:
..........................................................................
7.
Nationality (a) Present
........................................................................
(b) Past, if different and till which date
........................................................................
(c) Reasons for change
........................................................................
8.
Occupation:
(give address of place of work, if employed)
........................................................................
9.
Email ID:
...........................................................................
10. Permanent Address
........................................................................
11. Mailing address in India if any
........................................................................
12. Reference (a) in country of applicant
........................................................................
(b) in India
........................................................................
13. Passport No:
Issued by: ........................................... at .................................... Valid upto ....................................
14. Details of Visa for India, if any obtained
........................................................................
Issued by: ........................................... at .................................... Valid upto ....................................
15. Places proposed to be visited
........................................................................
16. Route intended to be followed
........................................................................
17. Purpose of visit
........................................................................
18. Likely date of visit
........................................................................
19. Likely duration of visit
........................................................................
20. Is any one accompanying the Applicant? If so,
please give detail
........................................................................
21. Arrangements for travel and accommodation
that may have been made
........................................................................
22. Details of previous visits to India
........................................................................
23. Has/Have he/she/they, previously visited any
restricted protected area in India or Bhutan?
If so, please give details of the places visited
and date of visit.
........................................................................
24. Has any earlier request for permit been refused?
If so, please furnish details
........................................................................
The information given above is correct and complete to the best of my knowledge.
Place. ...................................................
Date. ....................................................
Signature of the Applicant.
...........................................
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