EMBASSY OF INDIA KHARTOUM

ALAMARAT STREET 1, BLOCK 12 DH Paste your unsigned

recent color photograph.
PLOT NO. 2, KHARTOUM, SUDAN Size: 2" X 2"
https://eoikhartoum.in/
+249183574001

Visa Application Form

Signature

SDNK00503423

A. Personal Particulars (As in Passport)

Surname (As in Passport) ELSAIM
Application Id : SDNK00503423

Given Name (As in Passport) NASIER AHMED OSMAN ELSAIM

Previous/other Name if any Not Applicable
Gender MALE Marital Status MARRIED
Date of Birth 11-AUG-1969 Religion ISLAM
Place of Birth Town/City BAHRI Country of Birth SUDAN
Citizenship /National ID No 11722887219 Educational Qualification GRADUATE
Visible identification marks NONE
Current Nationality Nationality by Birth/
SUDAN Naturalization BY BIRTH
Any Other Previous/Past Nationality Not Applicable
B. Passport Details
Passport No. P05568271 Date of Issue ( dd/mm/yyyy ) 11-MAR-2019
Place of Issue BAHRI Date of Expiry ( dd/mm/yyyy ) 10-MAR-2024
Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Web Registration Date : 12-MAR-2023

Country of Issue Place of Issue

Passport/IC No. Date of issue (dd/mm/yyyy)
Nationality/Status
C. Applicant's Contact Details
Present ALMAOUNA STREET Phone No 09122789
Address BAHRI Mobile /Cell No
WWW.NASSER.AHMED7788990@GMAIL.
KHARTOUM, SUDAN 11111 Email address COM

Permanent ALMAOUNA STREET

Address BAHRI
KHARTOUM
D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
ALKOTAINA
Father's AHMED OSMAN ALSAIM SUDAN SUDAN SUDAN
ALKOTAINA
Mother's FAIZA ABDALLAH DAWOD SUDAN SUDAN
SOUTH GEZI
Spouse OMAIMA MOHAMMED ABDALLAH SUDAN SUDAN SUDAN
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO

NASIER AHMED OSMAN ELSAIM ELSAIM

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 SINGLE
Period of Visa ( Month) 9 Month Expected Date of Journey 25-MAR-2023
DELHI INDIRA GANDHI INTL, DELHI INDIRA GANDHI INTL,
Port Of Arrival TERM Port of Exit TREM
Required Detail of MEDICAL VISA
Hospital Name BLK MAK SUPRE SPECIALTY HOSPITAL
Address NEW DELHI
Doctor Name DR SAJAL AMANI
Phone/Fax +91 11 25752885
Details RHEUMATOID DISEASE
Purpose of Visit : FOR PATIENTS
F. Previous Visit Details
Have You Ever visited India ? YES
Address where You stayed in HYDERABAD
India PARAMOUNT , AKBER BULDING
Cities in India Visited HYDERABAD
Type of Visa MEDICAL VISA Visa Number VK96334079

Application Id : SDNK00503423
Visa Issued Place KHARTOUM Date of Issue 03-SEP-2018
Countries visited in last 10 years INDIA
Have you been refused an Indian Visa or extension of the same previously or deported from India ? NO
G. Profession/Occupation Details :
Present Occupation CHARTERED ACCOUNTANT Designation/Rank
Employer name/business GOVERNMENT
Employer Address
Phone Number BAHRI
Past occupation if any
Are/have you worked with Armed forces/ Police/ Para Military forces ? NO
Organization Designation
Place of Posting Rank
H. Details of Two Reference
In India In SUDAN
Name ARIFUL GAFOOR MOHAMMED ABDALGADER
Address NEW DELHI ALKHARTOUM BAHRI
NEW DELHI DELHI
Phone Number +918887125002 0912843105
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.
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.

12-MAR-2023 ................................
Date : ...................... Applicant's signature (as in Passport)