HIGH COMMISSION OF INDIA

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DHAKA(BANGLADESH) recent color photograph.
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Visa Application Form

Signature

BGDDV7582F24

A. Personal Particulars (As in Passport)

Surname (As in Passport) HASAN
Application Id : BGDDV7582F24

Given Name (As in Passport) NAHID

Previous/other Name if any Not Applicable
Gender MALE Marital Status SINGLE
Date of Birth 15-JUN-2001 Religion ISLAM
Place of Birth Town/City CUMILLA Country of Birth BANGLADESH
Citizenship /National ID No 3317036394 Educational Qualification OTHERS
Visible identification marks NILL
Current Nationality Nationality by Birth/
BANGLADESH Naturalization BY BIRTH
Any Other Previous/Past Nationality Not Applicable
B. Passport Details
Passport No. A04552236 Date of Issue ( dd/mm/yyyy ) 06-SEP-2022
Place of Issue DHAKA Date of Expiry ( dd/mm/yyyy ) 05-SEP-2032
Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO
Web Registration Date : 24-MAR-2024

Country of Issue Place of Issue

Passport/IC No. Date of issue (dd/mm/yyyy)
Nationality/Status
C. Applicant's Contact Details
Present R 5-98,5, A-28,HLD-77 Phone No 01926388971
Address D N A ROAD, NANDIPARA Mobile /Cell No 8801926388971
NARAYANGANJ, BANGLADESH
1400 Email address NAHIDHASAN1511719785@GMAIL.COM

Permanent NANDANNAGAR, KASBA

Address MANDABHAG
BRAHMANBARIA

D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
CUMILLA
Father's RONGO MIAH BANGLADESH BANGLADESH BANGLADESH
CUMILLA
Mother's NASIMA AKTER BANGLADESH BANGLADESH BANGLADESH
Marital Status Single
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO

NAHID HASAN
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 24-APR-2024
Port Of Arrival BY ROAD SRIMANTPUR Port of Exit BY ROAD SRIMANTPUR
Required Detail of TOURIST VISA
Places to be Visited AGARTALA, KOLKATA

Purpose of Visit : TOURISM,RECREATION,SIGHT-SEEING

F. Previous Visit Details
Have You Ever visited India ? NO
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 ? NO
G. Profession/Occupation Details :

Application Id : BGDDV7582F24
Present Occupation PRIVATE SERVICE Designation/Rank WORKER
Employer name/business BENGAL ENGINEERING CORPORATION
Employer Address PLOT-14, ROAD -9,SHYMPUR, KADAMTOLI, DHAKA-1204
Phone Number 01715789844
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 PRANTIK HOTEL NETAJI SUBHASH ROAD, OPPOSITE RCC, AGARTALA, WEST TRIPURA TRIPURA. 91 97741 30580,
2 .,
3 .,
4 .,
I. Details of Two Reference
In India In BANGLADESH
Name PRANTIK HOTEL NASIMA AKTER
NETAJI SUBHASH ROAD,
Address OPPOSITE RCC, AGARTALA NANDANNAGAR, KASBA
WEST TRIPURA TRIPURA BRAHMANBARIA
Phone Number 91 97741 30580 01926388971
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.

24-MAR-2024 ................................
Date : ...................... Applicant's signature (as in Passport)