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Nishana Abdul Muhsin, a 39-year-old married female citizen of Maldives, is applying for a 1-month medical visa to India to receive treatment for right shoulder impingement syndrome at Ganga Medical Centre in Coimbatore from December 20th-January 20th. This will be her first visit to India. She works as a customs officer for the Maldives government and will stay at Treebo Ess Grand hotel in Coimbatore during her visit.

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Mohamed Khan
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136 views2 pages

Ticket

Nishana Abdul Muhsin, a 39-year-old married female citizen of Maldives, is applying for a 1-month medical visa to India to receive treatment for right shoulder impingement syndrome at Ganga Medical Centre in Coimbatore from December 20th-January 20th. This will be her first visit to India. She works as a customs officer for the Maldives government and will stay at Treebo Ess Grand hotel in Coimbatore during her visit.

Uploaded by

Mohamed Khan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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EMBASSY OF INDIA, MALE

H. Athireege Aage, Ammeru Ahmed Magu


Male, Republic of Maldives Paste your unsigned
http://www.hcimaldives.com/ recent color photograph.
960-3323015 Size: 2” X 2”

Visa Application Form

Signature
MDVMV0297B18

A. Personal Particulars (As in Passport)


Surname (As in Passport) NISHANA ABDUL MUHSIN
Given Nam e (As in Passport) NISHANA
Previous/other Name if any
Sex FEMALE Marital Status MARRIED
Date of birth 02-AUG-1979 Religion ISLAM
Application Id :MDVMV0297B18

Place of Birth Town/City GD MAATHODA Country of Birth MALDIVES


Citizenship /National ID No A050100 Educational Qualification POST GRADUATE
Visible identification marks NILL
Current Nationality MALDIVES Nationality by Birth/ Naturalization BY BIRTH
Any Other Previous/Past Nationality
B. Passport Details
Passport No. LA18E5353 Date of issue ( dd/mm/yyyy ) 14-AUG-2018
Place of issue MALE Date of expiry (dd/mm/yyyy) 14-AUG-2023
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 : 06-DEC-2018

Nationality/status
C. Applicant’s Contact Details

M LINKIYA Phone No 7764327


Present
address MALE 9607764327
Mobile /Cell No

MAAFANU, MALDIVES 20287 Email address ITSME6601@GMAIL.COM

Permanent M LINKIYA
Address MALE
MAAFANU

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
GD THINADHOO
Father’s ABDUL MUHSHIN MALDIVES MALDIVES MALDIVES
MAATHODAA
Mother’s AISATH DIDI MALDIVES MALDIVES MALDIVES
MALE
Spouse MOHAMED HASHIM MALDIVES MALDIVES MALDIVES
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 DOUBLE


Period of Visa ( Month) 1 Month Expected Date of Journey 20-DEC-2018
Port Of Arrival COIMBATORE Port of Exit COIMBATORE

NISHANA NISHANA ABDUL MUHSIN


Required Detail of MEDICAL VISA
Hospital Name GANGA MEDICAL CENTRE AND HOSPITALS PVT LTD AASANNDHA
Address COINBATORE MALDIVES
Doctor Name FAZNEEN
Phone/Fax
Details RT SHOULDER IMPINGEMENT SYNDROME

Purpose of Visit : MEDICAL TREATMENT OF SELF


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

Application Id :MDVMV0297B18
Cities in India Visited
Type of Visa Visa Number
Visa Issued Place Date of Issue
Countries visited in last 10 years
SRILANKA, INDIA
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 GOVERNMENT SERVICE Designation/Rank CUSTOM OFFICER GRADE
Employer name/business CUSTOMS
Employer Address MALDIVES
Phone Number
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.

I. Details of Two Reference


In India In MALDIVES
Nam e TREEBO ESS GRAND HASHIM MOOSA
Address COIMBATORE NEHRU STREET SINAMALE 1 1305

Phone
919322800100 9607907437
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.

..……………………………………
06-DEC-2018
Date :………………………. Applicant’s signature (as in Passport)

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