HIGH COMMISSION OF INDIA
Paste your unsigned
DHAKA(BANGLADESH) recent color photograph.
Size: 2" X 2"
Visa Application Form
Signature
BGDDVAB26824
A. Personal Particulars (As in Passport)
Surname (As in Passport) ISLAM
Application Id : BGDDVAB26824
Given Name (As in Passport) MD NUR
Previous/other Name if any Not Applicable
Gender MALE Marital Status MARRIED
Date of Birth 03-JUN-1982 Religion ISLAM
Biometric Enrollment is not required till 04/APR/2028.
Place of Birth Town/City SIRAJGANJ Country of Birth BANGLADESH
Citizenship /National ID No 8819429650920 Educational Qualification HIGHER SECONDARY
Visible identification marks NILL
Current Nationality Nationality by Birth/
BANGLADESH Naturalization BY BIRTH
Any Other Previous/Past Nationality Not Applicable
B. Passport Details
Passport No. B00475936 Date of Issue ( dd/mm/yyyy ) 05-JUL-2022
Place of Issue DHAKA Date of Expiry ( dd/mm/yyyy ) 04-JUL-2032
Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Country of Issue Place of Issue
Web Registration Date : 12-MAY-2024
Passport/IC No. Date of issue (dd/mm/yyyy)
Nationality/Status
C. Applicant's Contact Details
Present KA14/5/1 Phone No 01724684609
Address NADDA Mobile /Cell No 8801724684609
DHAKA, BANGLADESH 1212 Email address NURISLAM1233654@GMAIL.COM
Permanent ISLAMPUR, ULLAPARA MODEL
Address BALSA BARI - 6760
SIRAJGANJ
D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
SIRAJGANJ
Father's MD SORHAB ALI BANGLADESH BANGLADESH
SIRAJGANJ
Mother's MST MOHILA KHATUN BANGLADESH BANGLADESH
SIRAJGANJ
Spouse MST SALMA KHATUN BANGLADESH BANGLADESH
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO
MD NUR ISLAM
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 27-JUN-2024
Port Of Arrival BY ROAD CHANGRABANDHA Port of Exit BY ROAD CHANGRABANDHA
Required Detail of TOURIST VISA
Places to be Visited KOLKATA
Purpose of Visit : TOURISM,RECREATION,SIGHT-SEEING
F. Previous Visit Details
Have You Ever visited India ? YES
Address where You stayed in SONALI RESORT PVT LIMITED
India MIRZA GALIB STREET, NEW MARKET , KOLKATA
Cities in India Visited KOLKATA
Type of Visa TOURIST VISA Visa Number VL8113569
Visa Issued Place DHAKA Date of Issue 01-MAY-2023
Countries visited in last 10 years INDIA
Have you been refused an Indian Visa or extension of the same previously or deported from India ? NO
G. Profession/Occupation Details :
Application Id : BGDDVAB26824
Present Occupation BUSINESS PERSON Designation/Rank PROPRIETOR
Employer name/business SAJER MAYA SAREE HOUSE
Employer Address ISLAMPUR, BALSA BARI, ULLAPARA, SIRAJGANJ
Phone Number 01724684609
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 WALSON 5A SUDDER ST, DHORMOTOLA, NEW MARKET KOLKATA WEST BENGAL. 919903329977,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India In BANGLADESH
Name HOTEL WALSON MST SALMA KHATUN
5A SUDDER STREET,
Address DHORMOTOLA ISLAMPUR, ULLAPARA MODEL,
KOLKATA KOLKATA WEST
BENGAL BALSA BARI- 6760, SIRAJGANJ
Phone Number 919903329977 01650138709
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.
12-MAY-2024 ................................
Date : ...................... Applicant's signature (as in Passport)
Biometric Enrollment is not required till 04/APR/2028.
