Visa Application Form

A. Personal Parti cul ars (As in Passport)

Surname
Name
Previous/other Name if any
Sex Marital Status
Date of birth Religion
Place of Birth Town/City Country of Birth
Citizenship /National ID No Educational Qualification
Visible identification marks
Current Nationality Nationality by Birth/ Naturalization
Any Other Previous/Past Nationality
B. Passport Detai l s
Passport No. Date of issue ( dd/mm/yyyy )
Place of issue Date of expiry (dd/mm/yyyy)
Any other Passport/Identi ty Certi fi cate hel d (i f yes ,pl ease fi ll i n the foll owing)
Country of issue Place of issue
Passport/IC No Date of issue(dd/mm/yyyy)
Nationality/status
C. Appl icant s Contact Detail s
Phone No
Mobile /Cell No

Present
address

Email address

Permanent
Address

D. Famil y Detail s

Rel ati on Name Nati onali ty Prev. Nat ional ity Pl ace/Country of Birth
Fathers
Mothers
Spouse
Were your Grandfather/Grandmother(Paternal/Maternal ) Paki stan Nati onals Or bel ong to Paki stan hel d area :
E. Detail s of Vi sa Sought
Type Of Visa Required No of Entries
Period of Visa Expected Date of J ourney
Port Of Arrival Port of Exit


Paste your unsigned
recent color photograph.
Size: 2 X 2


Signature
RUSM00530312
IVAN PETROV
MOSCOW
RUSSIAN FEDERATION
RUSSIAN FEDERATION
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VLADIVOSTOK
IVAN
RUSSIAN FEDERATION
RUSSIAN FEDERATION
+79105674567
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PETROVA OLGA
23-MAR-2010
23-MAR-2015
IVAN@MAIL.RU
6 Month
PETROV
Moscow
BY BIRTH
N/A
MOSCOW
KAZAN
RUSSIAN FEDERATION
NEW DELHI
BELOYARSKIY, TYUMENSKIY REGION
RUSSIAN FEDERATION
SEVASTOPOLSKAYA STR. 15-45
MOSCOW
MOSCOW
05-JUN-1975
RUSSIAN FEDERATION
6-8, Vorontsovo Polye
Double
PETROV VLADIMIR
Male
4730389561
RUSSIAN FEDERATION
7152456454
Married
NO
+74991234567
www.indianembassy.ru
NO
(Month)
PETROVA LIUDMILA
Embassy of India
15-NOV-2012
TOURIST VISA
PROFESSIONAL
MOSCOW
CHRISTIAN
SEVASTOPOLSKAYA STR. 15-45
MOSCOW, RUSSIAN FEDERATION 121345
+7-495-9810093
Required Detail of

Purpose of Visit :
F. Previ ous Vi si t Detail s
Have You Ever visited India ?
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
Have you been refused an Indian Visa or extension of the same previously or deported from India ?
If yes above mention when and by whom with control
No/Date

G. Professi on/Occupati on Detail s
Present Occupation Designation/Rank
Employer name/business
Employer Address
Phone Number

Past occupation if any
Are/have you worked with Armed forces/ Police/ Para Military forces ?
Organization Designation
Place of Posting Rank
H. Address of Place of Stay / Hotel
Place/Hotel Name Address of Place / Hotel State Phone No.

I. Detail s of Two Reference
In Indi a In
Name
Address
Phone
Number


J . 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.




..
Date :. Applicants signature (as in Passport)
PIROGOV ANDREY
NO
MOSCOW
RUSSIAN FEDERATION
INDIA, UKRAINE, BELARUS, ITALY, SPAIN, HUNGARY
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OOO IGRUSHKA
ENGINEER
KOMSOMOLSKAYA STR. 14-56
12-MAR-2009
21-AUG-2012
+74951221212
18, NOIDA-201301, NEW DELHI
AP4534819
ENGINEER
TVERSKAYA STR. 20
FF-10, ANSAL FORTUNE ARCADE SECTOR
4/68, W.E.A, KAROL BAGH, SARASWATI MARG, NEW DELHI - 110005
HOTEL JYOTI DELUXE
VAMANA TRAVELS INDIA PVT LTD
+911204236800
Places to be Visited
+74957111111
YES
TOURISM
NEW DELHI, MUMBAI
TOURIST VISA
TOURIST VISA
NEW DELHI, MUMBAI, VRINDAVAN