HIGH COMMISSION OF INDIA

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DHAKA(BANGLADESH)

Visa Application Form

Signature

BGDDY6F40115

A. Personal Particulars (As in Passport)

Surname (As in Passport)
AFTAB
Given Nam e (As in Passport) NAYEEM
Previous/other Name if any

Male
31-DEC-1989
NILPHAMARI
2694812094560
N/A
BANGLADESH

Sex

Web Registration Date : 01-DEC-2015

Application Id :BGDDY6F40115

Date of birth
Place of Birth Town/City
Citizenship /National ID No
Visible identification marks
Current Nationality

Marital Status
Religion
Country of Birth
Educational Qualification

Single
ISLAM
BANGLADESH
GRADUATE

Nationality by Birth/ Naturalization

BY BIRTH

Date of issue ( dd/mm/yyyy )

05-NOV-2014
04-NOV-2019

Any Other Previous/Past Nationality

B. Passport Details

BC0525331
DHAKA

Passport No.
Place of issue

Date of expiry (dd/mm/yyyy)

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)

Nationality/status
C. Applicants Contact Details
Present
address

367/4B
AHMED NAGOR, MIRPUR
DHAKA, BANGLADESH 1216

Phone No

+8801717181032
Email address nayeem696@gmail.com

Mobile /Cell No

Permanent WARD-08
Address
UKIL PARA
NILPHAMARI
D. Family Details
Relation

Name

Nationality

Prev. Nationality

Place/Country of Birth

Fathers

AFTAB UDDIN

BANGLADESH

BANGLADESH

NILPHAMARI
BANGLADESH

Mothers

NAZNEEN HOSSAIN

BANGLADESH

BANGLADESH

NILPHAMARI
BANGLADESH

Spouse
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

RESEARCH OR TRAINING VISA

Period of Visa (Month)

3 Month
BY RAIL GEDE

Port Of Arrival

NAYEEM AFTAB

No of Entries
Expected Date of Journey
Port of Exit

Double
09-DEC-2015
BY RAIL GEDE

Required Detail of

RESEARCH OR TRAINING VISA

Institution
Address
Phone
Email
Duration

DONA WORLD TECHNICAL TRAINING INSTITUTE

130(76), KAMAL PARK, BIRATI, KOLKATA: 700 051
+9103332562688

CSWIP

KKBHOWMICK@DONAWORLD.COM
1 MONTH

Purpose of Visit : OTHERS

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
CHINA
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 PRIVATE SERVICE
Designation/Rank
NDT ENGINEER
Employer name/business BANGLADESH INDUSTRIAL X-RAY
Employer Address HOUSE#10, ROAD# 2, SECTION# 11, MIRPUR, DHAKA
Phone Number
+8801963622600

Past occupation if any UN-EMPLOYED

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 DONA WORLD TECHNICAL TRAINING 130(76), KAMAL PARK, BIRATI, KOLKATA: 700 051 KOLKATA WEST BENGAL . +9103332562688, kkbhowmick@donaworld.com

2 .,
3 .,
4 .,
I. Details of Two Reference
In India
In BANGLADESH
Nam e MOUMITA,DONA WORLD TECHNICAL TRAINING INSTITUTE RAFIQUL ISLAM
Address 130(76), KAMAL PARK, BIRATI, KOLKAT
367/4B, AHMED NAGOR, MIRPUR, DHAKA
Phone
+9103332562688
Number

+8801781743183

J. DECLARATION:
a.
b.
c.
d.

I do not hold any other passport(s) other than those detailed above.
I have read and understood all the conditions for the visit to India and I am willing and able to abide fully by them.
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.
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.

01-DEC-2015
Date :.

..
Applicants signature (as in Passport)

Application Id :BGDDY6F40115

NO