HIGH COMMISSION OF INDIA
DHAKA(BANGLADESH) Paste your unsigned
recent color photograph.
Size: 2" X 2"
Visa Application Form
Signature
BGDDVD771822
A. Personal Particulars (As in Passport)
Surname (As in Passport) ALAM
Application Id : BGDDVD771822
Given Name (As in Passport) MOHAMMAD FOYSAL
Previous/other Name if any Not Applicable
Gender MALE Marital Status MARRIED
Date of Birth 03-OCT-1992 Religion ISLAM
Place of Birth Town/City CHANDPUR Country of Birth BANGLADESH
Citizenship /National ID No 1955747470 Educational Qualification GRADUATE
Visible identification marks SCARMARK IN FORHEAD
Current Nationality Nationality by Birth/
BANGLADESH Naturalization BY BIRTH
Any Other Previous/Past Nationality Not Applicable
B. Passport Details
Passport No. A03034829 Date of Issue ( dd/mm/yyyy ) 05-APR-2022
Place of Issue DHAKA Date of Expiry ( dd/mm/yyyy ) 04-APR-2032
Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Web Registration Date : 02-NOV-2022
Country of Issue Place of Issue
Passport/IC No. Date of issue (dd/mm/yyyy)
Nationality/Status
C. Applicant's Contact Details
HOUSE NO- 06, DHOUR MAIN
Present ROAD Phone No
KAMARPARA, NISHATNAGAR,
Address TURAG Mobile /Cell No 8801712341743
MOHAMMADFOYSALALAM6673@GMAIL.
DHAKA, BANGLADESH 1711 Email address COM
Permanent SAIYAL BARI
WEST ALONIA, NURNAGAR,
Address FARIDGANJ
CHANDPUR
D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
CHANDPUR
Father's MOHAMMAD KORSHED ALAM BANGLADESH BANGLADESH BANGLADESH
CHANDPUR
Mother's FERDOUSI ALAM BANGLADESH BANGLADESH BANGLADESH
NOAKHALI
Spouse FARHANA RAHMAN MIM BANGLADESH BANGLADESH BANGLADESH
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO
MOHAMMAD FOYSAL ALAM
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 12-NOV-2022
Port Of Arrival BY ROAD AGARTALA Port of Exit BY ROAD AGARTALA
Required Detail of TOURIST VISA
Places to be Visited KOLKATA, CHENNAI, MUMBAI
Purpose of Visit : TOURISM,RECREATION,SIGHT-SEEING
F. Previous Visit Details
Have You Ever visited India ? NO
Address where You stayed in
India ,
Cities in India Visited
Type of Visa Visa Number
Visa Issued Place Date of Issue
Countries visited in last 10
years
Have you been refused an Indian Visa or extension of the same previously or deported
Application Id : BGDDVD771822
from India ? NO
G. Profession/Occupation Details :
GENERAL PHYSICIAN AND
Present Occupation DOCTOR Designation/Rank PRACTITIONAR
Employer name/business KONABARI IBN SINA PVT HOSPITAL
Employer Address KONABARI, GAZIPUR
Phone Number 01670501016
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 HOTEL GREEN STAR 33 MIRZA GHALIP STREET FREE SHCOOL STREET KOLKATA WEST BENGAL. 03340716070,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India In BANGLADESH
Name HOTEL GREEN STAR DHOUR MAIN ROAD
Address 33, MIRZA GHALIB STREET, KAMARPARA, NISHATNAGAR, TURAG
KOLKATA-700016, W. B.
INDIA KOLKATA WEST
BENGAL DHAKA
Phone Number 03340716070 01818184087
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.
02-NOV-2022 ................................
Date : ...................... Applicant's signature (as in Passport)
