Writable Software Visa Application Form

VISA DEPARTMENT
Application Form

HIGH COMMISSION OF INDIA, INDIA HOUSE
ALDWYCH, LONDON, WC2B 4NA

FOR OFFICE USE ONLY

IMPORTANT: Read General Information on reverse carefully before filling this form. All columns of the application form must be correctly filled in BLOCK LETTERS and BLACK INK. Suppression of facts or furnishing misleading/false information will result in denial of visa without assigning any reason. Visa fee is not refundable.

Title:    Surname:

First Name:    Middle Name:

Maiden Name:    Alias (if any):

Date of Birth:    Place of Birth:    Nationality:

Passport No.:    Date of Issue:    Date of Expiry:

Passport issued by (Authority/Agency):    At (Place):

Father’s Name & Place of Birth:

Mother’s Name & Place of Birth:

Spouse’s Name & Place of Birth:

Occupation:    Business address:    Postcode:

Permanent Address:    Postcode:

Present Address:    Postcode:

Address to which Passport has to be sent (For postal applications):    Postcode:

Telephone No: Day/Work:    Evening:

Details of any other Passport / Nationality being held (by you) now or earlier:

Details of child / spouse (only if included on the passport and travelling with the applicant).

(Note that Visa is valid from date of issue. Check if you already hold a valid visa before applying)

Purpose of Visit:

Proposed Date of: (a) Arrival in India (at first entry):    (b) Departure from India:

Duration for which visa is required and No of Entries:

Places to be visited in India:

Was Visa refused earlier? Yes/No: If yes, please give details:

Name, Addresses and Telephone number of two referees in UK and in India who could be contacted in case of need.

UK: (1)    India: (1)

(2)    (2)

Declaration

I, hereby undertake that I shall utilise my visit for which Visa has been applied and shall not on arrival in India try to extend my stay for any other purpose. I declare that the information given here is true, accurate and complete.