ASSISTANT HIGH COMMISSION OF INDIA

CHITTAGONG(BANGLADESH)

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Visa Application Form

Signature

BGDC76813115

A. Personal Particulars (As in Passport)

Surname (As in Passport)
CHOWDHURY
Given Nam e (As in Passport) ARNAB
Previous/other Name if any
Sex

Web Registration Date : 02-AUG-2015

Application Id :BGDC76813115

Date of birth
Place of Birth Town/City
Citizenship /National ID No
Visible identification marks
Current Nationality

Male
17-OCT-1999
CHITTAGONG
NA
NA
BANGLADESH

Marital Status
Religion
Country of Birth
Educational Qualification

Single
HINDU
BANGLADESH
BELOW MATRICULATION

Nationality by Birth/ Naturalization

BY BIRTH

Date of issue ( dd/mm/yyyy )

26-JUL-2015
25-JUL-2020

Any Other Previous/Past Nationality

B. Passport Details

BH0076342
DHAKA

Passport No.
Place of issue

Date of expiry (dd/mm/yyyy)

Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Country of issue

Place of issue

Passport/IC No

Date of issue(dd/mm/yyyy)

Nationality/status
C. Applicants Contact Details
Present
address

17/A PANCHLAISH R/A ,

CHITTAGONG
CHITTAGONG, BANGLADESH 4203

Phone No

01714432000
Email address debashischy@gmail.com

Mobile /Cell No

Permanent WORD NO-- 04

Address
BANESWARPUR/GOBINDAPUR/MADHABPUR
HABIGANJ
D. Family Details
Relation

Name

Nationality

Prev. Nationality

Place/Country of Birth

Fathers

DEBASHISH CHOWDHURY

BANGLADESH

HABIGANJ
BANGLADESH

Mothers

SHILPI CHOWDHURY

BANGLADESH

CHITTAGONG
BANGLADESH

Spouse
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO
E. Details of Visa Sought

TOURIST VISA
(Month) 1 Month
BY RAIL GEDE/BY AIR

Type Of Visa Required

Period of Visa
Port Of Arrival

(Visa shall be valid from the Date of Issue and not from the Date of Journey)

ARNAB CHOWDHURY

No of Entries
Expected Date of Journey
Port of Exit

Single
08-AUG-2015
BY RAIL GEDE/BY AIR

TOURIST VISA

Places to be Visited

CALCUTTA

Purpose of Visit : TOURISM

F. Previous Visit Details
Have You Ever visited India ?
Address where You stayed in
India

NO

Cities in India Visited

Type of Visa
Visa Number
Visa Issued Place
Date of Issue
Countries visited in last 10 years
NA
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
No/Date
G. Profession/Occupation Details of Father
Present Occupation STUDENT
Designation/Rank
SR MERCHANDISER
Employer name/business SAAD MUSA GROUP (GARMENTS DIVISION)
Employer Address KHAJA ROAD,KULGAON,JALALABAD,CHITTAGONG
Phone Number
031-683951-3

Past occupation if any

Are/have you worked with Armed forces/ Police/ Para Military forces ? NO
Organization
Designation
Place of Posting
Rank
H. Address of Place of Stay / Hotel
Place/Hotel Name
Address of Place / Hotel

State

Phone No.

1 KOLKATA BARASHATH KOLKATA WEST BENGAL . 00918335858362, NA

2 .,
3 .,
4 .,
I. Details of Two Reference
In India
In BANGLADESH
Nam e LIMON CHOWDHURY
AMAL GHU
Address BARASHATH ,CALCUTTA
CDA COLONI, MEHEDIBAG R/A ,CHITTAGO
Phone
00918335858362
Number

031-2863499

J. DECLARATION:
a.
b.
c.
d.

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.

02-AUG-2015
Date :.

..
Applicants signature (as in Passport)

Application Id :BGDC76813115

Required Detail of