CONSULATE GENERAL OF INDIA
BIRGUNJ (NEPAL) Recent photo
(Size 3.5 cm
X
APPLICATION FOR REGISTRATION OF INDIAN NATIONALS 3.5cm)
1. Name: (Shri /Smt/ Master/ Ms) :
(in capital letters) _____________________________
2. Fathers / Husbands Name : Shri _____________________________
3. Date of Birth : _____________________________
4. Educational Qualification : _____________________________
5. Profession (please tick) : Student / Business / Service_______
6. Permanent address in India: (a) House/ Ward No___________________
(b) Mohalla / Vill _________________ Police Station ______________ (c)
Post Office _________________ District ____________________
(d) State ____________PIN _________ Phone _________________
7. (a) Name of School/ College/ Employer/ Shop in Nepal:
___________________________________________________________
Address: ___________________________________________________________________
__________________________ Phone________________________________
(b) Residential address in Nepal: ________________________________
____________________________________________________________________________
_____________________________ Phone ______________________________
8. Date / year of arrival in Nepal : _____________________________
9. Details of Documents (a): _____________________________
(Passport / Election Card/
Domicile or Caste Certificate/ (b): ______________________________________
Any other paper):
(c): ______________________________________
(d): ______________________________________
Place :
Date :
(Signature of the Applicant)