Required Detail of
Purpose of Visit :
F. Previous Visit Details
Have You Ever visited India ?
Address where You stayed in
Cities in India Visited
Type of Visa
Visa Issued Place
Date of Issue
Countries visited in last 10 years
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
G. Profession/Occupation Details
Past occupation if any
Are/have you worked with Armed forces/ Police/ Para Military forces ?
Place of Posting
H. Address of Place of Stay / Hotel
Address of Place / Hotel
I. Details of Two Reference
I do not hold any other passport(s) other than those detailed above.
I have read and understood all the conditions for the visit to India and I am willing and able to abide fully by them.
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.
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.
Applicant’s signature (as in Passport)