PART-I
Embassy of Pakistan
1.
3517 International Court N.W
Washington, D. C. 20008
[email protected]Your photographs must
be:
Passport size (45mm
high x 35mm wide)
(Visa Application Form)
A recent and likeness,
showing full face with no
hat, helmet or
sunglasses although you
can wear every day
glasses
TYPE OF VISA APPLIED FOR:
Diplomatic
Official
Military
Family
Transit
Journalist
Business
Tourist
Others
(specify)__________________________________
2.
Purpose of visit: ____________________________________________________________________________
3.
Duration of Stay :____________________________________________________________________________
4.
Visa required for: 01 month
5.
Number of Entries : Single
6.
i)
Port of Entry in Pakistan________________________________________________________________
ii.
Port of Departure from Pakistan _________________________________________________________
iii.
Place (s) to be visited in Pakistan :
06 months
1 year
Double
02 years
05 years
Multiple
a. ________________________________________b. ______________________________________________
7.
c. _________________________________________d.______________________________________________
SECTION -I (APPLICANTS PARTICULARS)
i.
Name as in Passport: ________________________
First
__________________ __________________________
Middle
Last
ii.
Date of Birth:
iii.
Place of Birth:
iv.
Sex:
vi.
Marital status:
vii.
Identification mark: ___________________________ viii. Native language____________________________
ix.
Nationality: (a) Present_____________________________(b) Previous ________________________________
__________________________________
dd/mm/yyyy
City_______________________________ Country______________________________
Male
Female
Single
v.
Blood Group______________
Married
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x.
Religion:_________________________________
8.
PASSPORT DETAILS:
Type of Passport/
UN Travel Document
Passport Number:
Date of issue:
Issuing authority
9.
Diplomatic
Official/Service
Ordinary
________________________________ Place of issue __________________________
________________________________ Date of Expiry___________________________
________________________________________________________________________
ADDRESS & CONTACT DETAILS:
a.
Address in USA/Country of Origin
__________________________________________________________
Telephone: i) Home____________________ ii) Work ____________________ iii) Cell ____________________
b.
Address in Pakistan _______________________________________________
Telephone: i) Home__________________ ii) Work____________________ iii) Cell _______________________
E-mail: _________________________________________________________________
10.
11.
Is your visit sponsored?
If yes, give details.
Name of Sponsor
_____________________
_____________________
_____________________
Yes
No
Address
Contact Number
____________________________ ______________________________
____________________________ ______________________________
____________________________ ______________________________
DETAILS OF PROFESSION :
a.
Profession :
_____________________________________________________________________________________
b.
Employers/sponsors details (in Pakistan/abroad (if applicable)
Name
Address
Home
Office
Cellular
Email address
b) In case of military services, (armed forces and allied services), Please fill in the proforma: Annexure A
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12.
DETAILS OF JOBS HELD IN THE PAST:
a.
c.
e.
f.
Designation___________________________ b.
Department __________________________
Duration (from-to)______________________ d.
Duties ______________________________
Job address & Phone No.______________________________________________________________
Name, address and contact numbers of the supervisor or a colleague, (use extra sheet if required):
_____________________________________________________________________________________
_____________________________________________________________________________________
13.
Are you applying visa from a third country?
Yes
No
If yes, please provide copy of Residence/Work Permit of that country
____________________________________________________________________________________________
14.
SECTION-II (FAMILY DETAILS)
i.
Name of mother __________________________ii. Nationality of mother_________________________
ii.
Name of father__________________________ iv. Nationality of father__________________________
v.
Spouse details:________________________________________________________________________
Name____________________________________ Nationality __________________________________
Date and place of birth__________________________________________________________________
Profession:_________________________
Name, address and contact number of the employer of spouse (if any) _________________________
_____________________________________________________________________________________
15.
Do you have any children?
Yes
If yes, please provide details for each of your child.
No
Date of birth
Name
________________________________________________________________ ________________________
________________________________________________________________ ________________________
16.
Please list any accompanying person / family member (including children) travelling with you to Pakistan.
Full Name
1.__________________________
2.__________________________
3.__________________________
Date of Birth
______________
______________
______________
Passport No. (if any)
_____________________
_____________________
_____________________
Address
_____________________
_____________________
_____________________
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17.
Do you have any bank account in Pakistan :
Bank Name
___________
___________
___________
18.
Branch
_____________
_____________
_____________
A/C Number
______________
______________
______________
Yes
No
Address
_____________________
_____________________
_____________________
Verifier details
___________________
___________________
___________________
TRAVEL HISTORY:
i.
Have you ever visited Pakistan during last five years? Yes
if yes, please provide details:
No
Date
Destination/Address
Purpose
Duration
1._________________________________________________________________________________________
2._________________________________________________________________________________________
3._________________________________________________________________________________________
4._________________________________________________________________________________________
5._________________________________________________________________________________________
ii.
Details of other countries visited, during last two years:
Date
Destination/Address
Purpose
Duration
1.__________________________________________________________________________________________
2.__________________________________________________________________________________________
3.__________________________________________________________________________________________
4.__________________________________________________________________________________________
iii.
iv.
Have you ever been refused a visa for any country, including Pakistan?
Yes
Have you ever been refused entry on arrival in Pakistan?
If yes, please provide details of refusal.
Yes
No
No
1.__________________________________________________________________________________________
2.__________________________________________________________________________________________
3.__________________________________________________________________________________________
4.__________________________________________________________________________________________
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19.
Have you ever been deported, removed or ordered to leave any country,
including Pakistan?
Yes
No
If yes, please provide details of refusal.
1._________________________________________________________________________________________
2.________________________________________________________________________________________
3._________________________________________________________________________________________
4._________________________________________________________________________________________
20.
Date
Do you have any criminal convictions or been charged in any country?
Yes
No
If yes, please provides details.
Country
Offence
Sentence
21. DECLARATION:
I declare that the information given in this form is correct to the best of my knowledge and
belief and if any of the particulars furnished above are found to be incorrect or withheld the visa is liable to
be rejected/cancelled at any time
Date___________________
__________________
(Signature of Applicant)
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PROCESSING CERTIFICATE
(FOR OFFICIAL USE NOT TO BE FILLED BY APPLICANT)
1.
2.
3.
4.
Date of receipt of visa application _____________________________________________________________
Registration No. ___________________________________________________________________________
Visa fee received___________________________________________________________________________
Additional documents received________________________________________________________________
a.
c.
5.
6.
_______________________________
_____________________________
____________________________________
____________________________________
Particulars of official who checked the visa form for its corrections and supporting documents:
Name: _______________________________
Designation: ______________________________________
Date: _______________________________
Signature:
__________________________
Details of clearance received from Ministry of Interior.
No. __________________________
7.
b.
d.
Date:
_______________
Decision of office Incharge:
a.
c.
d.
e.
g.
Accepted
b.
Regretted
Type of visa issued: _____________________________________________________
Duration: ______________________________________________________________
Single Entry
f. Multiple Entry
No. of entries: __________________________________________________________
Date: _________________________
___________________________
(Signature of Visa Issuing Authority)
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