EMBASSY OF INDIA KHARTOUM

ALAMARAT STREET 1, BLOCK 12 DH

PLOT NO. 2, KHARTOUM, SUDAN Paste your unsigned
https://eoikhartoum.in/ recent color photograph.
+249183574001 Size: 2” X 2”

Visa Application Form

Signature
SDNK00948018

A. Personal Particulars (As in Passport)

Surname (As in Passport) HAMED
Given Nam e (As in Passport) ALI HASSAN OMER
Previous/other Name if any
Sex MALE Marital Status SINGLE
Date of birth 20-MAY-1998 Religion ISLAM
NYALA SUDAN
Application Id :SDNK00948018

Place of Birth Town/City Country of Birth

Citizenship /National ID No 19454720096 Educational Qualification MATRICULATION
Visible identification marks BLACK SKIN
Current Nationality SUDAN Nationality by Birth/ Naturalization BY BIRTH
Any Other Previous/Past Nationality
B. Passport Details
Passport No. P03426944 Date of issue ( dd/mm/yyyy ) 27-SEP-2016
Place of issue NYALA Date of expiry (dd/mm/yyyy) 26-OCT-2021
Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Country of issue Place of issue
Passport/IC No Date of issue(dd/mm/yyyy)
Web Registration Date : 29-MAR-2018

Nationality/status
C. Applicant’s Contact Details

13324 Phone No 00249909097867

Present
address KHARTOUM SUDAN Mobile /Cell No

14457, SUDAN 13324 Email address

Permanent 14459
Address

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
NYALA
Father’s HASSAN OMER HAMED SUDAN SUDAN SUDAN
NYALA
Mother’s FATIMA KHALIL MOHAMMED SUDAN SUDAN SUDAN

Spouse

Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO

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 STUDENT VISA No of Entries SINGLE

Period of Visa ( Month) 12 Month Expected Date of Journey 20-MAY-2018
Port Of Arrival BANGALORE AIRPORT Port of Exit

ALI HASSAN OMER HAMED

 Required Detail of STUDENT VISA
Institution KARNATAKA COLLEGE OF MANAGEMENT THREE YEARS
Address HEGDE NAGAR MAIN ROAD, YELAHANKA HOBLI, BANGALORE
Phone 00919160595697
Email
Course Detail COMPUTER APPLICATIONS

Purpose of Visit : STUDYING REGULAR COURSES IN UNIVERSITIES IMPARTING HIGER EDUCATION

F. Previous Visit Details
Have You Ever visited India ? NO
Address where You stayed in
India
,

Application Id :SDNK00948018
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. Profession/Occupation Details of Father
Present Occupation STUDENT Designation/Rank
Employer name/business HASSAN OMER HAMED
Employer Address KHARTOUM SUDAN
Phone Number
0024990909
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.

I. Details of Two Reference

In India In SUDAN
Nam e AHMED SALAH HASSAN OMER HAMED
Address BENGALURU, KARNATAKA 560064 KHARTOUM SUDAN

Phone
00919160595697 00249909097867
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.

..……………………………………
29-MAR-2018
Date :………………………. Applicant’s signature (as in Passport)