APPLICATION FORM
( Registration Extension and Visa Extension )
230721K153XS
Application ID No. 230721K153XS Final Submission Date Fri Jul 23 22:54:40 IST 2021
FOR OFFICE USE ONLY
Reg. No. B 0 0 5 B G D 2 0 2 1
Personal Details
Surname KONIKA
Given Name AFRUZA HOSSAIN Paste your
Sex Female Date of Birth 07/10/1995 Height (in cm) 163 Recent passport size
Age as on today Year(s) 25 Month(s) 9 Day(s) 17 photograph here
Place of Birth MYMENSINGH,MYMENSINGH,BANGLADESH
Father's Name ABUL HOSSAIN
Mother's Name FATEMA KHANAM
Spouse's Name
Religion ISLAM Any Identification mark(s) preferably BLACK SPOT ON LIPS
visible
Present nationality BANGLADESH Previous nationality
Manner of acquiring present nationality Birth
Date of acquiring present nationality
Whether holding dual NO
nationality? If yes, Name of the country of second nationality
provide the following:- Passport No. of second country
Date of Issue
Date of Expiry
Whether travelled on this passport earlier to
India
Whether person of Indian Origin NO
Address of last residence (Outside India)
Address WARD-6 17/5 MILONBAG,MYMENSINGH SADAR, MYMENSINGH
City MYMENSINGH Country BANGLADESH
Address intended for longer stay in India (Registration)
Address 52 BIHARI LAL PAUL STREET,BARANAGAR ,KOLKATA-700036,P.S-BARANAGAR,NORTH 24 PARGANAS.
City/ District KOLKATA State WEST BENGAL
Pin Code 700036
Phone Number Mobile Number 9330877368
Any Other Address in India
Address
City/ District State
Pin Code
Phone Number Mobile Number
Email/Occupation/Profession Details
E-Mail Id konika.bdnet@gmail.com
Profession/Occupation STUDENT
Passport Details
Passport Number EB0450801 Place of Issue BANGLADESH, DHAKA
Date of Issue 15/07/2019 Expiry Date 14/07/2024
Visa Details
Visa Number VL3062760 Place of Issue BANGLADESH, DHAKA
Date of Issue 25/07/2019 Expiry Date 24/07/2021
Valid For Multiple Entry Visa Type STUDENT VISA
Special endorsement, if any
Organization/Company/Institute/Hospital Details
Name RABINDRA BHARATI UNIVERSITY
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230721K153XS
Application ID No. 230721K153XS
Address EMERALD BOWER CAMPUS:56 A.B.T ROAD KOLKATA-700050.JORA SANKO CAMPUS:6/4 DWARAKANATH TAGORE LANE
KOLKATA-700007
State WEST BENGAL City KOLKATA
Telephone Number Email ID
Employer EPFO ID Establishment ID
Arrival Details
Place of embarkation/boarding for India MYMENSINGH,MYMENSINGH,BANGLADESH
Date of arrival in India 21/07/2021
Place of disembarkation/arrival in India PETRAPOLE
Mode of Journey Road Flight/ Ship/ Bus/ Train No.
Purpose of visit to India Studies
Previous Registration Details in India
Registration Number Place of Registration Visa Type Duration From To
Details of family members/attendant/dependents, if any accompanying.
Name Nationality Passport Number Relationship
Person to be contacted in Case of Emergency
Name Relationship
Address City
Country Phone Number
Category Others
Military service details
Organisation Designation
Rank Place of Last Posting
Country of Last Posting
Current Registration Details
Are you registered in current locality FRRO/FRO in the current visit? YES Current WB0200453720
Registration No.
Current Extension Details
Have you got extended visa in current visit in current locality NO Current
FRRO/FRO? Extension No.
Visa Extension Details
Whether previously in India? NO
Whether permission to stay in India has been previously refused? NO
Whether permission to extend stay in India has been previously granted? NO
Period of Extension requried Year(s) 0 Month(s) 11 Day(s) 0
Reason for extension STUDIES NOT COMPLETED
In case of Missionary - Nature of work
Registration Extension Details
Current Registration Valid Upto 24/07/2021 Required for period of Year(s) 0 Month(s) 11 Day(s) 0
Reason Of Extension STUDIES NOT COMPLETED
Signature of the Applicant
Date_ _ _ _ _ _ _ _ _ _ _ _ _
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230721K153XS
Application ID No. 230721K153XS
List of mandatory and non mandatory documents
Mandatory Documents.
1. Photo : Applicant's Photo
2. Visa : Indian Visa
3. Residence proof : Residence Certificate from Hostel/Updated Form 'C' generated by Hotel/Lodge or Registered/Notarized Lease Deed, Utility Bill, Copy of photo-ID of the landlord along
with declaration and Tenant Police Verification
4. Passport : Bio-Data page of Passport along with page bearing last Indian Immigration arrival stamp
5. Financial resource proof : NRO account details and Scholarship letter (if any)
6. Bonafide certificate : Bonafide Certificate to be obtained from a UGC or AICTE recognized Institute/College/University mentioning Foreign Students’ Information System (FSIS) No.,
course undertaken, duration of course and e-mail ID of the Institute/College/University
7. Registration Certificate : FRRO/FRO Registration Certificate/Residential Permit of the Student (S-1) Visa holder
Registration office address
Office Name : FRRO Kolkata
Address : Office of the FRRO, 237 Jagadish Chandra Bose Road
City/District : KOLKATA
State : WEST BENGAL
Pin Code :
Phone Number : 033-22818640
Office opening time: 12.00 closing time: 17.30
There is no need to submit hard copy to concerned
FRRO/FRO
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