BGDCV324F222MD820101
BGDCV324F222MD820101
BGDCV324F222MD820101
Signature
BGDCV324F222
SHABNAGAR, KOTWALI
Permanent MODEL,
CUMILLA CANTOMENT-
Address 3501,CUMILLA
CUMILLA
D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
CUMILLA
Father's MD SHAMSUL HOQUE BANGLADESH BANGLADESH BANGLADESH
CUMILLA
Mother's MST FIROZA AKTER BANGLADESH BANGLADESH BANGLADESH
CUMILLA
Spouse SUMAIYA AKTER BANGLADESH BANGLADESH BANGLADESH
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO
MD AKBOR HOSSAIN
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 TOURIST VISA No of Entries MULTIPLE
Period of Visa ( Month) 12 Month Expected Date of Journey 30-NOV-2022
Port Of Arrival BY ROAD SRIMANTPUR Port of Exit BY ROAD SRIMANTPUR
Required Detail of TOURIST VISA
Places to be Visited KOLKATA,DELHI,AGARTALA
Application Id : BGDCV324F222
from India ? NO
G. Profession/Occupation Details :
Present Occupation BUSINESS PERSON Designation/Rank OWNER
Employer name/business SECURE CYBER CAFE
311, CHANDPUR BABY STAND,GANGCHAR,CUMILLA
Employer Address SADAR
Phone Number 01612011045
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 HOTEL POLO TOWERS AGARTALA VIP ROAD, KRISHNA NAGAR NORTH TRIPURA TRIPURA. +91 381231 0110,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India In BANGLADESH
HOTEL POLO TOWERS
Name AGARTALA SUMAIYA AKTER
Address VIP ROAD, KRISHNA NAGAR SHABNAGAR, KOTWALI MODEL,
WEST TRIPURA TRIPURA CUMILLA CANTONMENT-3501,CUMILLA
Phone Number +913812310110 01612011045
K. 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.
e. I will also submit hard-copy all the uploaded documents along with the print of application to submit to the concerning Indian
Mission or Agency for processing of visa application.
07-NOV-2022 ................................
Date : ...................... Applicant's signature (as in Passport)