Visa Application Form Page 3
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4AFFIX
CONSULATE GENERAL OF INDIA
1990 POST OAK BLVD # 600, HOUSTON, TX 77056
ONE
TEL: (713) 626-2148/49
FAX: (713) 626-2450
PHOTO
Email:cgi-hou@swbell.net
HERE
Website:
VISA APPLICATION FORM
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_______
mm / dd / 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/PASSPORT HELD AT PRESENT OR IN PAST(Give details)
11. PRESENT ADDRESS:
12. PHONE (HOME):
(WORK)
13. PERMANENT ADDRESS:
14. PROFESSION:
15. EMPLOYER’S NAME AND ADDRESS:
16. PASSPORT NUMBER:
17. VALID UNTIL:
(mm/dd/yyyy)
18. ISSUED AT:
19. ISSUE DATE:
(mm/dd/yyyy)
20. FATHER’S/HUSBAND’S NAME:
21. NATIONALITY OF FATHER/HUSBAND:
22. NAME AND NATIONALITY OF MOTHER
23. TYPE OF VISA REQUIRED (please circle):
Tourist_____|
Business_____|
Student_____|
Entry_____|
Transit_____|
Journalist_____|
Conference_____|
Employment_____|
Other_____|
24. PERIOD OF VISA:
15 Days* _____ |
Six Months_____ |
One Year_____ |
Five Years_____ |
Ten Years_____ |
PAGE 1 of 2
(* For Transit Only)
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