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Visa inde
- 1. Visa Application Form A. Personal Particulars (As in Passport) Surname (As in Passport) Given Name (As in Passport) Previous/other Name if any Sex Marital Status Date of birth Religion Place of Birth Town/City Country of Birth Citizenship /National ID No Educational Qualification Visible identification marks Current Nationality Nationality by Birth/ Naturalization Any Other Previous/Past Nationality B. Passport Details Passport No. Date of issue ( dd/mm/yyyy ) Place of issue Date of expiry (dd/mm/yyyy) Any other Passport/Identity Certificate held (if yes ,please fill in the following) Country of issue Place of issue Passport/IC No Date of issue(dd/mm/yyyy) Nationality/status C. Applicants Contact Details Phone No Mobile /Cell No Present address Email address Permanent Address D. Family Details Relation Name Nationality Prev. Nationality Place/Country of Birth Fathers Mothers Spouse Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : 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 No of Entries Period of Visa Expected Date of Journey Port Of Arrival Port of Exit Paste your unsigned recent color photograph. Size: 2 X 2 Signature NLDT04044214 PATTIE ANN PARKINSON VARKEVISSER HENDRIK IDO AMBACHT UNITED STATES OF AMERICA UNITED STATES OF AMERICA WebFileNumber:NLDT04044214 SAN FRANCISCO PATTIE ANN UNITED STATES OF AMERICA NETHERLANDS UNITED STATES OF AMERICA 06 37559794 WebRegistrationDate:22-SEP-2014 MUMBAI MAARTEN VARKEVISSER 20-MAR-2013 456221940 20-MAR-2018 pattivarkevisser@gmail.com 1 Month UNITED STATES OF AMERICA PARKINSON VARKEVISSER THE NETHERLANDS NATURALIZATION NO WHITTIER HOLLYWOOD 27-JUL-2009 NETHERLANDS MUMBAI KATWIJK NETHERLANDS UITERWAARD 24 HENDRIK IDO AMBACHT ZUID HOLLAND AMSTERDAM 31-DEC-1975 UNITED STATES OF AMERICA BUITENRUSTWEG 2, 2517 KD ,THE HAGUE Single MD PARKINSON Female 239261185 UNITED STATES OF AMERICA NXKRJ30L2 Married NO 078 614 8070 www.indianembassy.nl YES (Month) UNITED STATES OF AMERICA CD HASH EMBASSY OF INDIA 16-OCT-2014 TOURIST VISA HIGHER SECONDARY HENDRIK IDO AMBACHT CHRISTIAN UITERWAARD 24 ZUID HOLLAND, NETHERLANDS 3344ED 0031 70 3469771
- 2. Required Detail of Purpose of Visit : F. Previous Visit Details Have You Ever visited India ? Address where You stayed in India Cities in India Visited Type of Visa Visa Number Visa Issued Place Date of Issue Countries visited in last 10 years 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 Designation/Rank Employer name/business Employer Address Phone Number Past occupation if any Are/have you worked with Armed forces/ Police/ Para Military forces ? Organization Designation Place of Posting Rank H. Address of Place of Stay / Hotel Place/Hotel Name Address of Place / Hotel State Phone No. I. Details of Two Reference In India In Name Address Phone 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. .. Date :. Applicants signature (as in Passport) FAM. HAASNOOT NO THE HAGUE NETHERLANDS US, INDIA, THAILAND, FRANCE, & ITALY WebFileNumber:NLDT04044214 SALMAN FURNITURE HOUSE WIFE SCHIMMELPENNICKSTRAAT 77 08-APR-2014 22-SEP-2014 071 4032937 MANGALAPRUAM,CHENNAI 600012(FRIEND) 7756142 STUDENT 655 GREEN VIEW ROAD, LA HABRA CA USA 31, FIRST STREET, KRISHNADOSS ROAD, 2221KZ KATWIJK 31, FIRST STREET, KRISHNADOSS ROAD,, MANGALAPRUAM, CHENNAI 600012 of Father H. LAMECH INBARAJ H. LAMECH INBARAJ 00914426620212 Places to be Visited 562 6915911 YES TOURISM CHENNAI & MUMBAI TOURIST VISA TOURIST VISA DELHI, OOTY, CHENNAI