HIGH COMMISSION OF INDIA

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Visa Application Form

Signature
BGDDXB91F117

A. Personal Particulars (As in Passport)

Appointment Date : 06-DEC-2017 At : 10.00 Hrs.

Surname (As in Passport) PAUL
Given Name (As in Passport) TUMPA
Previous/other Name if any
Sex FEMALE Marital Status MARRIED
Date of birth 09-APR-1992 Religion HINDU
Application Id :BGDDXB91F117

Place of Birth Town/City KHULNA Country of Birth BANGLADESH

Citizenship /National ID No 19920110886000077 Educational Qualification GRADUATE
Visible identification marks NILL
Current Nationality BANGLADESH Nationality by Birth/ Naturalization BY BIRTH
Any Other Previous/Past Nationality
B. Passport Details
Passport No. BJ0590098 Date of issue ( dd/mm/yyyy ) 15-DEC-2015
Place of issue DHAKA Date of expiry (dd/mm/yyyy) 14-DEC-2020
Any other Passport/Identity Certificate held (if yes ,please fill in the following) YES
Country of issue BANGLADESH Place of issue KHULNA
Passport/IC No Y0311147 Date of issue(dd/mm/yyyy) 30-MAR-2009
Web Registration Date : 29-NOV-2017

Nationality/status BANGLADESH

Khulna
C. Applicants Contact Details

92, CHOTO BOYRA KUNDU PARA Phone No 01914662672

Present
address KHULNA GPO, SONADANGA Mobile /Cell No 1914662672
KHULNA, BANGLADESH 9000 Email address

Permanent 92, CHOTO BOYRA KUNDU PARA

Address KHULNA GPO, SONADANGA
KHULNA

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
KHULNA
Fathers TUSHAR KANTI PAUL BANGLADESH BANGLADESH BANGLADESH
KHULNA
Mothers RITA RANI PAUL BANGLADESH BANGLADESH BANGLADESH
KHULNA
Spouse AVIJIT KUMAR KUNDU BANGLADESH BANGLADESH 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)

Type Of Visa Required TOURIST VISA No of Entries MULTIPLE

Period of Visa ( Month) 12 Month Expected Date of Journey 14-DEC-2017
Port Of Arrival BY AIR/ HARIDASPUR Port of Exit BY AIR/ HARIDASPUR

TUMPA PAUL
 Required Detail of TOURIST VISA
Places to be Visited KOLKATA

Purpose of Visit : TOURISM

F. Previous Visit Details
Have You Ever visited India ? YES
Address where You stayed in ASHOK KUMAR PAUL
India
PATHARGHATA, RAJARHAT, NORTH 24 PGS, WB

Application Id :BGDDXB91F117
Cities in India Visited KOLKATA
Type of Visa TOURIST VISA Visa Number VK1816925
Visa Issued Place DHAKA Date of Issue 17-MAR-2016
Countries visited in last 10 years
INDIA
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 Spouse
Present Occupation HOUSE WIFE Designation/Rank HOUSE WIFE
Employer name/business TUMPA PAUL
Employer Address 92 CHOTO BOYRA KUNDU PARA SONADANGA KHULNA
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 State Phone No.
1 DK INTERNATIONAL HOTEL 11/1A MARQUSE STREET KOLKATA WEST BENGAL. 22556282,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India In BANGLADESH
Nam e ASHOK KUMAR PAUL AVIJIT KUMAR KUNDU
Address PATHARGHATA, RAJARHAT 92, CHOTO BOYRA KUNDU PARA
NORTH 24 PGS, WB SONADANGA, KHULNA
Phone
00919775644312 01914662672
Number

J. DECLARATION:

a. I do not hold any other passport(s) other than those detailed above.
b. I have read and understood all the conditions for the visit to India and I am willing and able to abide fully by them.
c. 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.
d. 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.

..
29-NOV-2017
Date :. Applicants signature (as in Passport)