Scribd Logo
Upload

Welcome to Scribd!

  • 37 views

    High Commission of India: Visa Application Form

    Uploaded by

    af
    1) The document is a visa application form submitted by MD Shahinur Islam to the High Commission of India in Dhaka, Bangladesh. 2) Shahinur is applying for a medical visa to visit India for 12 months for cardiac treatment at hospitals in Bangalore, including Narayana Hrudayalaya and the National Institute of Cardiovascular Diseases in Dhaka. 3) He declares that the information provided is complete and correct and that he will abide by the conditions for his visit to India.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    High Commission of India: Visa Application Form

    Uploaded by

    af
    37 views2 pages
    1) The document is a visa application form submitted by MD Shahinur Islam to the High Commission of India in Dhaka, Bangladesh. 2) Shahinur is applying for a medical visa to visit India for 12 months for cardiac treatment at hospitals in Bangalore, including Narayana Hrudayalaya and the National Institute of Cardiovascular Diseases in Dhaka. 3) He declares that the information provided is complete and correct and that he will abide by the conditions for his visit to India.

    Original Title

    BGDDV2470221MD890331

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    1) The document is a visa application form submitted by MD Shahinur Islam to the High Commission of India in Dhaka, Bangladesh. 2) Shahinur is applying for a medical visa to visit India for 12 months for cardiac treatment at hospitals in Bangalore, including Narayana Hrudayalaya and the National Institute of Cardiovascular Diseases in Dhaka. 3) He declares that the information provided is complete and correct and that he will abide by the conditions for his visit to India.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    37 views2 pages

    High Commission of India: Visa Application Form

    Uploaded by

    af
    1) The document is a visa application form submitted by MD Shahinur Islam to the High Commission of India in Dhaka, Bangladesh. 2) Shahinur is applying for a medical visa to visit India for 12 months for cardiac treatment at hospitals in Bangalore, including Narayana Hrudayalaya and the National Institute of Cardiovascular Diseases in Dhaka. 3) He declares that the information provided is complete and correct and that he will abide by the conditions for his visit to India.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    HIGH COMMISSION OF INDIA

    DHAKA(BANGLADESH) Paste your unsigned


    recent color photograph.
    Size: 2” X 2”

    Visa Application Form

    Signature
    BGDDV2470221

    A. Personal Particulars (As in Passport)


    Surname (As in Passport) ISLAM
    Given Nam e (As in Passport) MD SHAHINUR
    Previous/other Name if any
    Sex MALE Marital Status MARRIED
    Date of birth 31-MAR-1989 Religion ISLAM
    MANIKGONJ BANGLADESH
    Application Id :BGDDV2470221

    Place of Birth Town/City Country of Birth


    Citizenship /National ID No 5617883971184 Educational Qualification GRADUATE
    Visible identification marks NIL
    Current Nationality BANGLADESH Nationality by Birth/ Naturalization BY BIRTH
    Any Other Previous/Past Nationality
    B. Passport Details
    Passport No. A00417362 Date of issue ( dd/mm/yyyy ) 08-MAR-2021
    Place of issue DHAKA Date of expiry (dd/mm/yyyy) 07-MAR-2031
    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 : 30-SEP-2021

    Nationality/status
    C. Applicant’s Contact Details

    KOLA Phone No 01687896739


    Present
    address KOLA Mobile /Cell No 1687896739
    MANIKGONJ, BANGLADESH 1850 Email address

    Permanent KOLA
    Address KOLA
    MANIKGONJ

    D. Family Details
    Relation Name Nationality Prev. Nationality Place/Country of Birth
    MANIKGONJ
    Father’s MD HABIBUR RAHMAN BANGLADESH BANGLADESH BANGLADESH
    MANIKGONJ
    Mother’s ANGORI BEGUUM BANGLADESH BANGLADESH BANGLADESH
    RAJBARI
    Spouse JANNATUL FERDOUSH BANGLADESH BANGLADESH BANGLADESH
    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 MEDICAL VISA No of Entries MULTIPLE


    Period of Visa ( Month) 12 Month Expected Date of Journey 15-OCT-2021
    Port Of Arrival BY AIR Port of Exit BY AIR

    MD SHAHINUR ISLAM
    Required Detail of MEDICAL VISA
    Hospital Name NARAYANA HRUDAYALAYA LIMITED NATIONAL INSTITUTE OF CARDIOVASCULAR DISEASES
    Address BANGALORE 560099 SHER E BANGLA NAGAR DHAKA 1207
    Doctor Name DR DEVI SHETTY PROF DR KAMRUL HASAN
    Phone/Fax 919538262600 029122560
    Details CARDIAC

    Purpose of Visit : FOR PATIENTS


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

    Application Id :BGDDV2470221
    Cities in India Visited
    Type of Visa Visa Number
    Visa Issued Place Date of Issue
    Countries visited in last 10 years
    NO
    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
    Present Occupation PRIVATE SERVICE Designation/Rank RECEPTIONIST CUM MANAGER
    Employer name/business AL EHSAN DIGITAL DIAGNOSTIC CENTER
    Employer Address UTHALY SHIBALYA MANIKGONJ
    Phone Number
    01716223870
    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.
    1 NARAYANA STUDIO APARTMENTS KIADB FLATS 2ND MAIN 1ST BLOCK KORAMANGALA BANGALORE KARNATAKA. 919740899591,
    2 .,
    3 .,
    4 .,
    I. Details of Two Reference
    In India In BANGLADESH
    Nam e NARAYANA HRUDAYALAYA LIMITED MD ALOMGIR HOSSAIN
    Address 258A BOMMASANDRA IA HASUR ROAD 412 DIN KG SCHOOL PAIKPARA
    BANGALORE 560099 MIRPUR DHAKA
    Phone
    919538262600 01712632219
    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.

    ..……………………………………
    30-SEP-2021
    Date :………………………. Applicant’s signature (as in Passport)

    You might also like