VISA APPLICATION FORM FOR THE KINGDOM OF BHUTAN

(Please fill in block capital)

1. Name in Full: _______________________________________________________
(Surname)
Passport
2. Date of Birth: _________/_____________/________________(DD-MM-YYYY)
3. Sex: Male Female Marital Status: Married Single
size Photo
4. Nationality: .________________________________________________________________________
5. Passport No: ___________________________ Place of issue: ________________________________
Date of Issue: ___________________________Valid until: ___________________________________
(DD MMYYYY) (DD MMYYYY)
6. Nature of Passport: Diplomatic Official Ordinary UN Laissez Passer
7. Permanent Address: __________________________________________________________________
Tel No.________________________
8. Occupation/Profession: ________________________________________________________________
9. Period for which visa is required: from ______________________________to ___________________
(DD MMYYYY) (DD MMYYYY)
10. Port of entry/exit: Entry Port ______________________ Exit Port _______________________________
11. Purpose of visit to Bhutan: _____________________________________________________________
12. Are you accompanying your spouse/parents/children? Yes No
If Yes, name of the spouse/parents/children ________________________________________________
13. Is this your first visit to Bhutan? Yes No
If No, give details of earlier visit(s) __________________________________________________
__________________________________________________________________________________
I hereby declare that the statement given above is true and correct. I am aware that the Bhutanese immigration
laws do not permit me to indulge in any activity other than the one stated above. I fully understand that
providing false information to the Immigration Authorities or indulging in other activities would result in
cancellation of my visa and deportation thereof.
Date: _____________________________
Place: _____________________________ Signature of Applicant: _________________

For Official use only

Approved/Not Approved/Others _________________________________

Signature of the Approving Officer _______________________________