Asst High Commission of India Rajshahi

House No-284, Sector-2,Housing Estate

Uposhahar,Rajshahi

Paste your unsigned

recent color photograph.
Size: 2 X 2

www.ahcirajshahi.org
00880721861213

Visa Application Form

Signature

BGDR57772216

A. Personal Particulars (As in Passport)

Surname (As in Passport)
AKANDA
Given Nam e (As in Passport) MD ABDUL BASED
Previous/other Name if any
Sex

Application Id :BGDR57772216

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

Marital Status
Religion
Country of Birth
Educational Qualification

MARRIED
ISLAM
BANGLADESH
GRADUATE

Nationality by Birth/ Naturalization

BY BIRTH

Date of issue ( dd/mm/yyyy )

25-AUG-2014
24-AUG-2019

Any Other Previous/Past Nationality

B. Passport Details

BB0891227
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) YES
Country of issue

Web Registration Date : 27-OCT-2016

MALE
03-OCT-1960
BOGRA
19601022001008430
NIL
BANGLADESH

Passport/IC No
Nationality/status

BANGLADESH
W0124205
BANGLADESH

Place of issue
Date of issue(dd/mm/yyyy)

BOGRA
13-JAN-2010

C. Applicants Contact Details

Present
address

SULTANGANJPARA, BOGRA SADAR

BOGRA SADAR,BOGRA SADAR
BOGRA, BANGLADESH 5800

Phone No

1871471151

Mobile /Cell No

1716543527

Email address

Permanent SULTANGANJPARA, BOGRA SADAR

Address
BOGRA SADAR,BOGRA SADAR
BOGRA
D. Family Details
Relation

Name

Nationality

Prev. Nationality

Place/Country of Birth

Fathers

SOLAIMAN AKANDA

BANGLADESH

BANGLADESH

BOGRA
BANGLADESH

Mothers

MOST BOKULA BEWA

BANGLADESH

BANGLADESH

BOGRA
BANGLADESH

Spouse

MST MINARA BEGUM

BANGLADESH

BANGLADESH

BOGRA
BANGLADESH

Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO

E. Details of Visa Sought

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

TOURIST VISA
(Month) 12 Month
BY ROAD HILI

Type Of Visa Required

Period of Visa
Port Of Arrival

MD ABDUL BASED AKANDA

No of Entries
Expected Date of Journey
Port of Exit

MULTIPLE
15-NOV-2016
BY ROAD HILI

TOURIST VISA

Purpose of Visit : TOURISM

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

YES

KOLKATA
KOLKATA,

Cities in India Visited KOLKATA

Type of Visa TOURIST VISA
Visa Issued Place RAJSHAHI
Countries visited in last 10 years

Application Id :BGDR57772216

Required Detail of

VK1499859

Visa Number
Date of Issue

18-APR-2016

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
Present Occupation BUSINESS PERSON
Designation/Rank
NA
Employer name/business NA
Employer Address NA
Phone Number
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

1 HOTEL ROYAL GARDEN 163 A PARK STREET KOLKATA WEST BENGAL. 5555411221,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India
LIMA
Nam e HOTEL ROYAL GARDEN
Address 163 A PARK STREET
SYEDPUR

In

State

Phone No.

BANGLADESH

WB,KOLKATA

Phone
5555411221
Number

01674114112

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.

27-OCT-2016
Date :.

..
Applicants signature (as in Passport)