APPLICATION FORM

( Registration )
2804147T5Q2R
Application ID No. 2804147T5Q2R Appointment Date and Time 29/04/2014 11.00
FOR OFFICE USE ONLY
Reg. No. B 0 0 1 M M R 2 0 1 4
Personal Details
Surname
Given Name BIAK LAL
Sex Male Date of Birth 03/03/1983 Height (in cm) 0
Age as on today Year(s) 31 Month(s) 1 Day(s) 25
Place of Birth SINGGIAL,CIKHA,MYANMAR (BURMA)
Father's Name KAM SUAN
Mother's Name
Spouse's Name
Any Identification mark(s) preferably visible NIL
Paste your
Recent passport size
photograph here
Present nationality MYANMAR (BURMA) 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 SINGGIAL, CIKHA TOWNSHIP, CHIN STATE
City CIKHA Country MYANMAR (BURMA)
Address intended for longer stay in India (Registration)
Address POLE NO-61, HASTSAL, UTTAM NAGAR
City/ District DELHI State DELHI
Pin Code 110059
Phone Number Mobile Number 7503275227
Any Other Address in India
Address
City/ District State
Pin Code
Phone Number Mobile Number
Email/Occupation/Profession Details
E-Mail Id
Profession/Occupation OTHERS
Passport Details
Passport Number 30500079362 Place of Issue INDIA, NEW DELHI
Date of Issue 04/08/2011 Expiry Date 09/05/2015
Visa Details
Visa Number Place of Issue ,
Date of Issue Expiry Date
Valid For Visa Type
Special endorsement, if any
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2804147T5Q2R
Application ID No. 2804147T5Q2R Appointment Date 29/04/2014
Organization/Company/Institute/Hospital Details
Name
Address
State City
Telephone Number Email ID
Arrival Details
Place of embarkation/boarding for India KHENMAN,CIKHA,MYANMAR (BURMA)
Date of arrival in India 18/12/2010
Place of disembarkation/arrival in India HILLI
Mode of Journey Others Flight/ Ship/ Bus/ Train No.
Purpose of visit to India Others
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
Refugee
Military service details
Organisation Designation
Rank Place of Last Posting
Country of Last Posting
Signature of the Applicant
Date_ _ _ _ _ _ _ _ _ _ _ _ _
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2804147T5Q2R
Application ID No. 2804147T5Q2R Appointment Date 29/04/2014
Instruction
Document required for Registration
Registration office address
Office Name : FRRO NEW DELHI
Address : EAST BLOCK 8, SECTOR 1 , R.K. PURAM, NEW DELHI
City/District : DELHI
State : DELHI
Pin Code : 0
Phone Number : 01126711443
Office opening time: 9.30 closing time: 18.00
Applications are accepted upto 15.00
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