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To be eligible to fill this form, the applicant must be a citizen of India.
Surname (As in Passport)
Given Name (As in Passport)
Previous/other Name if any
Gender
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
Any Other Previous/Past Nationality
Passport Number
Date of issue
Date of expiry
Place of issue
Present Address
Phone Number
Mobile /Cell Number
Email address
Permanent Address
DECLARATIONI do not hold any other passport(s) other than those detailed above.I have read and understood all the conditions for the visit to India and I am willing and able to abide fully by them.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.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.
Signature of Applicant
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Date