Visa Application Form Page 4

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25. HAVE YOU EVER VISITED INDIA BEFORE?
If yes, give address where you stayed with dates or years:
26. HA INDIAN VISA OR EXTENSION OF THE SAME EVER REFUSED TO YOU PREVIOUSLY?
Yes______ No________ If yes, give details:
27. ARE YOU HOLDING A VALID “NO OBJECTION TO RETURN TO INDIA” ENDORSEMENT?
Yes______ No________ If yes, give details:
28. OBJECT OF JOURNEY:
29. ARE YOU TRAVELLING ON BEHALF OF A COMPANY?
Yes______ No_______
30. IF YES, GIVE NAME AND ADDRESS OF COMPANY:
31. EXPECTED DATE OF DEPARTURE FROM USA:
(mm/dd/yyyy)
32. EXPECTED DATE OF ARRIVAL IN INDIA:
(mm/dd/yyyy)
33. PORT OF ARRIVAL IN INDIA:
34. ARE ANY CHILDREN IN YOUR PASSPORT ACCOMPANYING YOU?
Yes______ No______ If yes, give details:
Full Name
Date of Birth(mm/dd/yyyy)
Sex
(a) _____________________________________________________________________________________________________________________________________
(b) _____________________________________________________________________________________________________________________________________
35. NAME AND ADDRESS OF TWO REFERENCES:
(a) In India: ______________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
(b) In applicant’s country: __________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________
I, ___________________________________________________________________ hereby undertake that I shall
utilize my visit to India for the purpose for which the visa has been applied for and shall not, on arrival in India, try to
obtain employment or set up business or extend my stay for any other purpose.
_____________________________
Signature of Applicant
Place: __________________________________
Date: ___________________________________
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