EMBASSY OF INDIA, MALE

H. Athireege Aage, Ammeru Ahmed Magu

Male, Republic of Maldives Paste your unsigned
http://www.hcimaldives.com/ recent color photograph.
960-3323015 Size: 2” X 2”

Visa Application Form

Signature
MDVMV0297C18

A. Personal Particulars (As in Passport)

Surname (As in Passport) MOHAMED HASHIM
Given Nam e (As in Passport) MOHAMED HASHIM
Previous/other Name if any
Sex MALE Marital Status MARRIED
Date of birth 26-DEC-1977 Religion ISLAM
Application Id :MDVMV0297C18

Place of Birth Town/City MALE Country of Birth MALDIVES

Citizenship /National ID No A024244 Educational Qualification PROFESSIONAL
Visible identification marks NILL
Current Nationality MALDIVES Nationality by Birth/ Naturalization BY BIRTH
Any Other Previous/Past Nationality
B. Passport Details
Passport No. LA17E9953 Date of issue ( dd/mm/yyyy ) 21-JUN-2018
Place of issue MALE Date of expiry (dd/mm/yyyy) 21-JUN-2023
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)
Web Registration Date : 06-DEC-2018

Nationality/status
C. Applicant’s Contact Details

G SINAMALE 1 Phone No 9607798231

Present
address MALE 9607798231
Mobile /Cell No

GALOLHU, MALDIVES 20112 Email address ITSME6601@GMAIL.COM

Permanent G SINAMALE 1
Address MALE
GALOLHU

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
MALE
Father’s MOHAMED HASHIM MALDIVES MALDIVES MALDIVES
MALE
Mother’s FATHIMATH NAZIRA MALDIVES MALDIVES MALDIVES
MAATHODA
Spouse NISHANA ABDUL MUHSIN MALDIVES MALDIVES MALDIVES
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 MEDICAL ATTENDANT No of Entries DOUBLE

Period of Visa ( Month) 1 Month Expected Date of Journey 20-DEC-2018
Port Of Arrival COIMBATORE Port of Exit COIMBATORE

MOHAMED HASHIM MOHAMED HASHIM

 Required Detail of MEDICAL ATTENDANT
Dependency Name NISHANA ABDUL MUHSIN
Dependency Date of Birth 02/08/1979
Dependency Nationality MALDIVES
Dependency Passport No LA18E5353

Purpose of Visit : MEDICAL ATTENDANT OF PATIENT

F. Previous Visit Details
Have You Ever visited India ? NO
Address where You stayed in
India
,

Application Id :MDVMV0297C18
Cities in India Visited
Type of Visa Visa Number
Visa Issued Place Date of Issue
Countries visited in last 10 years
COLOMBO,BANGKOK, MALAYSIA, DUBAI, INDIA AND CHINA
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 ENGINEER Designation/Rank CONSULTANT
Employer name/business BUCG MALDIVES
Employer Address MALDIVES
Phone Number
Past occupation if any MILITARY
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.

I. Details of Two Reference

In India In MALDIVES
Nam e TREEBS ESS GRAND HASHIM MOOSA
Address NERU STREET G SINA MALE

Phone
919322800100 9607907437
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.

..……………………………………
06-DEC-2018
Date :………………………. Applicant’s signature (as in Passport)