APPLICATION FORM

( Visa Extension )
08051425M7CW
Application ID No. 08051425M7CW Appointment Date and Time 09/05/2014 11.00
FOR OFFICE USE ONLY
Reg. No. B 0 0 1 M M R 2 0 1 4
Personal Details
Surname
Given Name CIN LIAN MUNG
Sex Male Date of Birth 05/07/1992 Height (in cm) 170
Age as on today Year(s) 21 Month(s) 10 Day(s) 3
Place of Birth GAWNGMUAL VILLAGE, TEDIM TOWNSHIP, CHIN STATE,TEDIM,MYANMAR
(BURMA)
Father's Name ZEN KHAN THANG
Mother's Name NING KHAW CIIN
Spouse's Name
Any Identification mark(s) preferably visible NIL
Paste your
Recent passport size
photograph here
Present nationality MYANMAR (BURMA) Previous nationality
Manner of acquiring present nationality Birth
Date of acquiring present nationality
Whether holding dual NO
nationality? If yes, Name of the country of second nationality
provide the following:- Passport No. of second country
Date of Issue
Date of Expiry
Whether travelled on this passport earlier
to India
Whether person of Indian Origin
NO
Address of last residence (Outside India)
Address GAWNGMUAL VILLAGE, TEDIM TOWNSHIP, CHIN STATE
City TEDIM Country MYANMAR (BURMA)
Address intended for longer stay in India (Registration)
Address PLOT NO: 56-A FF LEFT SIDE, HASTSAL, UTTAM NAGAR
City/ District DELHI State DELHI
Pin Code 110059
Phone Number Mobile Number 8800264393
Any Other Address in India
Address
City/ District State
Pin Code
Phone Number Mobile Number
Email/Occupation/Profession Details
E-Mail Id
Profession/Occupation OTHERS
Passport Details
Passport Number 30500070799 Place of Issue INDIA, NEW DELHI
Date of Issue 27/07/2011 Expiry Date 06/05/2015
Visa Details
Visa Number Place of Issue ,
Date of Issue Expiry Date
Valid For Visa Type
Special endorsement, if any
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08051425M7CW
Application ID No. 08051425M7CW Appointment Date 09/05/2014
Organization/Company/Institute/Hospital Details
Name
Address
State City
Telephone Number Email ID
Arrival Details
Place of embarkation/boarding for India TIO,TEDIM,MYANMAR (BURMA)
Date of arrival in India 01/03/2009
Place of disembarkation/arrival in India HILLI
Mode of Journey Others Flight/ Ship/ Bus/ Train No.
Purpose of visit to India Others
Previous Registration Details in India
Registration Number Place of Registration Visa Type Duration From To
Details of family members/attendant/dependents, if any accompanying.
Name Nationality Passport Number Relationship
Person to be contacted in Case of Emergency
Name Relationship
Address
City Country
Phone Number
Category
Refugee
Military service details
Organisation Designation
Rank Place of Last Posting
Country of Last Posting
Current Registration Details
Are you registered in current locality FRRO/FRO in the current visit? YES Current
Registration No.
DL02/NVI/MMR/429/2013
Current Extension Details
Have you got extended visa in current visit in current locality
FRRO/FRO?
NO Current
Extension No.
Visa Extension Details
Wether Previously in India?
Whether Permission to stay in India has been Previously refused?
Whether Permission to extend stay in India has been Previously
granted?
Period of Extension requried Year(s) Month(s) 12 Day(s)
Reason for extension LEGAL STAYING
In case of Missionary - Nature of work
Signature of the Applicant
Date_ _ _ _ _ _ _ _ _ _ _ _ _
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08051425M7CW
Application ID No. 08051425M7CW Appointment Date 09/05/2014
Instruction
Document required for Visa Extension
Registration office address
Office Name : FRRO NEW DELHI
Address : EAST BLOCK 8, SECTOR 1 , R.K. PURAM, NEW DELHI
City/District : DELHI
State : DELHI
Pin Code : 0
Phone Number : 01126711443
Office opening time: 9.30 closing time: 18.00
Applications are accepted upto 15.00
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