|
Effective 5th March, 2001. This form is
to be used by all applicants residing in the following states: |
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Please affix one passport size photograph here and
enclose one more photograph |
CONSULATE GENERAL OF INDIA
3 EAST 64TH STREET ( BET. MADISON AND
FIFTH AVE.)
NEW YORK, NEW YORK 10021
TEL. (212) 774-0600 . FAX: (212) 570-9581
E-Mail:[email protected]
(visit our website: indiacgny.org)
VISA APPLICATION FORM
FOR OFFICE USE ONLY
CHECKED / CLEARED
SIGNATURE ______________
·
Passport in original
valid for a minimum of six months beyond date of intended departure from India
should accompany visa application.
·
PHOTO: Please enclose two
passport size photographs with visa application.
·
Please tender exact
amount in the form of Money Order/ Bank Draft/Certified Check in the name of CONSULATE
GENERAL OF INDIA or by CASH at the counter in bills no larger
than $50/- WE DO NOT ACCEPT PERSONAL CHECKS .
·
Applications are received
from 9:15 AM to 12:15 PM on working days and serviced passports are delivered
between 4:30 p.m. and 5:15 p.m.
·
VALIDITY OF VISA
STARTS FROM THE DATE OF ISSUE.
·
THIS FORM MAY BE FREELY
DUPLICATED .
·
Please check instructions
on filling up this form. Instructions can be obtained from the Consulate
General of India, New York or from our website at indiacgny.org.
(Please print or type)
1. Full Name:_________________________________________________________
(First)
(Middle)
(Last)
2. Last name at birth(if
different):________________________________________
3. Marital status:
Married/Unmarried___________________________________
4. If married give maiden
name:________________________________________
5. Date of Birth:___/___/___
6. Sex: Male__ Female__
mm dd yy
7. Place of birth:__________________________________________________________
8. Current
nationality:_________________________________________________
9. Are you a
permanent/long-term resident in USA? Yes____ No____
If yes, please attach copy
of your Green-Card/Long-Term Visa status ( For Non-US passport holders only)
10. Nationality at
birth:____________________________________________________
11. Any other nationality
held at present or in the past:_________________________
(Are you in possession of any
other passport?)
12. Present
Address:_____________________________________________________
_______________________________________________________________________
13.
Phone:__________________________(Home)_______________________(Work)
14. Permanent Address:_________________________________________________
________________________________________________________________________
15.
Profession:___________________________________________________________
16. Employer's Name and
Address:__________________________________________
________________________________________________________________________
17. Passport
Number:________________________________ 18. Valid Till:_________
19. Issued
At:_______________________________________ 20. Issue Date:________
21. Father's/Husband's
Name:______________________________________________
22. Nationality of
Father/Husband:__________________________________________
23. Name and Nationality of
Mother:________________________________________
24. Type of Visa required:____Tourist,
____Business, ____Student, ____Entry, ____Transit (short stop over while
travelling to a third country), _____Journalist, ____Other
25. Period of Visa:____Days
(For Transit with confirmed onward ticket only ), _____Six Months, _____One Year,
______Five years (for persons of Indian origin only, Six months each
visit/Continuous stay ), ______ Ten years (for US citizens only)
26. Have you ever visited
India before? Yes___ No___ If yes, give address where you stayed with dates:
________________________________________________________
________________________________________________________________________
27. Has Indian visa or
extension of same ever been refused to you previously? Yes__ No___ If yes, give
details: _______________________________________________
________________________________________________________________________
28. Are you holding a valid
"NO OBJECTION TO RETURN TO INDIA" endorsement?
Yes_____ No_____
If yes, give details (for foreigners resident in India only) : __________________________
________________________________________________________________________
29. Purpose of
Journey:____________________________________________________
30. Are you travelling on
behalf of a company? Yes____ No____
31. If yes, give name and
address of company:_________________________________
________________________________________________________________________
32. Expected date of
departure from USA:____________ 33. Expected date of arrival in
India:__________
34. Port of arrival in
India:_________________________________________________
35. Are any children included
in your passport accompanying you? Yes____ No_____
If yes, give details:
Full Name Date
of Birth Sex
(a)_____________________________________________________________________
(b)_____________________________________________________________________
36. Name and address of two
references:
(a) In
India:_______________________________________________________
________________________________________________________________________
________________________________________________________________________
(b) In applicant's
country:_________________________________________________
________________________________________________________________________
________________________________________________________________________
I,
______________________________________________, hereby undertake that I shall
utilise my visit to India for the purpose for which the visa has been applied
for and shall not, on arrival in India, try to obtain employment or set up
business or extend my stay for any other purpose.
Declaration to be made by
applicants seeking to stay in India for more than one year:
"I hereby undertake to
undergo any medical test (s), including an AIDS test, within one month of my
arrival in India. In case I test positive for AIDS, I agree to leave
India".
Signature of
applicant:______________________ Date:_______________ Place:_________