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HIGH COMMISSION OF INDIA

DHAKA(BANGLADESH) Paste your unsigned


recent color photograph.
Size: 2" X 2"

Visa Application Form

Signature
BGDDV7EEDD22

A. Personal Particulars (As in Passport)


Surname (As in Passport) BAUL
Application Id : BGDDV7EEDD22

Given Name (As in Passport) RAZES CHANDRA


Previous/other Name if any Not Applicable
Gender MALE Marital Status SINGLE
Date of Birth 22-OCT-2000 Religion HINDU
Place of Birth Town/City MUNSHIGANJ Country of Birth BANGLADESH
Citizenship /National ID No 7365340798 Educational Qualification HIGHER SECONDARY
Visible identification marks LEFT EYE IS BIT SMALL
Current Nationality Nationality by Birth/
BANGLADESH Naturalization BY BIRTH
Any Other Previous/Past Nationality Not Applicable
B. Passport Details
Passport No. A03144087 Date of Issue ( dd/mm/yyyy ) 10-FEB-2022
Place of Issue DHAKA Date of Expiry ( dd/mm/yyyy ) 09-FEB-2027
Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Web Registration Date : 25-JUL-2022

Country of Issue Place of Issue


Passport/IC No. Date of issue (dd/mm/yyyy)
Nationality/Status
C. Applicant's Contact Details
Present #68 Phone No
Address KHANEPUR Mobile /Cell No 88001858807190
NARSINGDI, BANGLADESH
1611 Email address [email protected]

Permanent #68
Address DORIYA HOWLAPARA, POLASH
NARSINGDI

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
NARSINGDI
Father's SREEROBI CHANDRA BAUL BANGLADESH BANGLADESH BANGLADESH
GAZIPUR
Mother's SHILA BAUL BANGLADESH BANGLADESH BANGLADESH
Marital
Status Single
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO

RAZES CHANDRA BAUL


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 03-AUG-2022
BY RAIL GEDE/BYROAD BY RAIL GEDE/BYROAD
Port Of Arrival HARIDASPUR Port of Exit HARIDASPUR
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 ? 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

Application Id : BGDDV7EEDD22
Have you been refused an Indian Visa or extension of the same previously or deported
from India ? NO
G. Profession/Occupation Details :
ASSISTANT MAINTENANCE
Present Occupation PRIVATE SERVICE Designation/Rank ENGINEER
Employer name/business BENLI ELECTRONIC ENTERPRISE COMPANY LIMITED
Employer Address
Phone Number CHOWDHURY BARI, VOGRA BYPASS, GAZIPUR
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 CHANDERNAGORE GUEST HOUSE BARASAT HOOGHLY WEST BENGAL. 09432672043,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India In BANGLADESH
Name BISHWAJIT MONDAL SREEROBI CHANDRA BAUL
N S ROAD, NAMKUNDU,
Address BHADRESSWAR, HOOGHLY #68, KHANEPUR , POLAS, NARSINGDI
HOOGHLY WEST BENGAL
Phone Number +918910422779 +8801814174699
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.

25-JUL-2022 ................................
Date : ...................... Applicant's signature (as in Passport)

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