HIGH COMMISSION OF INDIA
Paste your unsigned
DHAKA(BANGLADESH) recent color photograph.
Size: 2" X 2"
Visa Application Form
Signature
BGDDVDFD7F24
A. Personal Particulars (As in Passport)
Surname (As in Passport) HASAN
Application Id : BGDDVDFD7F24
Given Name (As in Passport) RAKIBUL
Previous/other Name if any Not Applicable
Gender MALE Marital Status SINGLE
Date of Birth 25-DEC-2001 Religion ISLAM
Biometric Enrollment is not required till 23/DEC/2028.
Place of Birth Town/City LAKSHMIPUR Country of Birth BANGLADESH
Citizenship /National ID No 7813767345 Educational Qualification HIGHER SECONDARY
Visible identification marks BLACK SIMBLE IN FACE
Current Nationality Nationality by Birth/
BANGLADESH Naturalization BY BIRTH
Any Other Previous/Past Nationality Not Applicable
B. Passport Details
Passport No. A00169070 Date of Issue ( dd/mm/yyyy ) 03-DEC-2020
Place of Issue DHAKA Date of Expiry ( dd/mm/yyyy ) 02-DEC-2030
Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Country of Issue Place of Issue
Web Registration Date : 27-JUN-2024
Passport/IC No. Date of issue (dd/mm/yyyy)
Nationality/Status
C. Applicant's Contact Details
Present 5/1 LALMATIA BLOCK-D Phone No 56655546
Address DHANMONDI Mobile /Cell No 8801764700458
DHAKA, BANGLADESH 1207 Email address
[email protected] Permanent LAL MIA MUNSHI BARI
Address GOBINDOPUR
LAKSHMIPUR
D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
LAKSHMIPUR
Father's A K M SAIFULLAH BANGLADESH BANGLADESH BANGLADESH
LAKSHMIPUR
Mother's HASINA AKTER BANGLADESH BANGLADESH BANGLADESH
Marital Status Single
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO
RAKIBUL HASAN
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 30-JUL-2024
Port Of Arrival BY AIR/ HARIDASPUR Port of Exit BY AIR/ HARIDASPUR
Required Detail of TOURIST VISA
Places to be Visited AGRA DELHI KOLKATA
Purpose of Visit : TOURISM,RECREATION,SIGHT-SEEING
F. Previous Visit Details
Have You Ever visited India ? YES
Address where You stayed in L POCKET SARITHA BIHAR
India ,
Cities in India Visited DELHI
Type of Visa TOURIST VISA Visa Number VN0533329
Visa Issued Place DHAKA Date of Issue 26-DEC-2023
Countries visited in last 10 years
Have you been refused an Indian Visa or extension of the same previously or deported from India ? NO
G. Profession/Occupation Details : of Father
Application Id : BGDDVDFD7F24
Present Occupation STUDENT Designation/Rank PROPRIETOR
Employer name/business SNEHA SUPER SHOP
Employer Address
Phone Number 26/15 DHANMONDI DHAKA
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 ASHOKA PALACE ARAKSHAN ROAD,PAHARGANJ NEW DELHI DELHI. 917481927237,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India In BANGLADESH
Name PRAVIN DIPTO
Address ASHOKA PALACE 5/1 LALMATIA DHAKA
NEW DELHI DELHI
Phone Number 917481927237 01635532518
K. 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.
e. I will also submit hard-copy all the uploaded documents along with the print of application to submit to the concerning Indian Mission
or Agency for processing of visa application.
27-JUN-2024 ................................
Date : ...................... Applicant's signature (as in Passport)
Biometric Enrollment is not required till 23/DEC/2028.
