1. Ordinary Passport 2. Diplomatic Passport 3. Official Passport 4. Service Passport

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1 Passport Type* 1. Ordinary Passport 2. Diplomatic Passport 3. Official Passport 4. Service Passport 5. Special Passport 1. Nationality * Port of Arrival* Ahmedabad Airport Amritsar Airport Bagdogra Airport Bengaluru Airport Calicut Airport Chennai Airport Chandigarh Airport Cochin Airport Coimbatore Airport Delhi Airport Gaya Airport Goa Airport Guwahati Airport Hydrabad Airport Jaipiur Airport Kolkata Airport Lucknow Airport Mangalore Airport Mumbai Airport Nagpur Airport Pune Airport Tiruchirapalli Airport Trivandrum Airport Varanasi Airport Vishakapatnam Airport Cochin SEA PORT Goa SEA PORT Mangalore SEAPORT Mumbai SEAPORT Chennai SEAPORT Date of Birth* Expected Date of Travel* Visa Type* (e-tourist/e-business/e-medical) Surname (as shown in your Passport) * Given Name/s (as shown in your Passport) *

2 Have you ever changed your name? If yes please give name and Surname Sex* Date of Birth * Town/City of birth * Country of birth * Citizenship/National Id No. * Religion * Visible identification marks * Educational Qualification * (Higher Secondary/Marticulation/Graduate/Post Graduate/Professional/Illiterate) Nationality * Did you acquire Nationality by birth or by naturalization? * By Birth or Naturalization If by Naturalization please mention Prev. Nationality Have you lived for at least two years in the country where you are applying visa? Yes or No Passport No. * Place of Issue * Date of Issue * Date of Expiry * Any other valid Passport/Identity Certificate(IC) held, Yes / No if Yes please give details* Country of Issue Passport/IC No. Date of Issue Place of Issue Nationality mentioned therein ADDRESSE DETAILS* (PRESENT ADDRESS) House No./Street* Village/Town/City * State/Province/District * Postal/Zip Code* Country* Phone No. Mobile No* Address

3 Permanent Address If same please mention same as above or give below details House No./Street Village/Town/City State/Province/District Father's Details (please give this detail even if your father is not alive) * Previous Nationality Mother's Details (please give this detail even if your father is not alive) * Previous Nationality Applicant's Marital Status* (SINGLE/MARRIED) Spouse's Details (HUSBAND OR WIFE DETAILS) * Previous Were your Grandfather/ Grandmother (paternal/maternal) Pakistan Nationals or Belong to Pakistan held area. Yes or No if Yes give details* Profession / Occupation Details of Applicant* Present Occupation* Employer Name/business* Designation* Phone Past Occupation, if any Previous Indian Visa/Currently valid Visa Details

4 Have you ever visited India before? Yes or No If Yes please give details Cities previously visited in India * Last Indian Visa No/Currently valid Indian Visa No. * Type of Visa * Place of Issue * Date of Issue * Has permission to visit or to extend stay in India previously been refused? Yes or No if Yes please give details If so, when and by whom (Mention Control No. and date also) SAARC Country Visit Details* Have you visited SAARC countries (except your own country) during last 3 years? Yes or No if Yes please give details below 1. Afghanistan 2. Bhutan 3. Pakistan 4. Maldives 5. Bangladesh 6. Nepal 7. Sri Lanka Year No. of Visits NAME OF THE COMPANY TO BE VISITED IN INDIA, ADDRESS, TELEPHONE NUMBER, WEBSITE OF THAT COMPANY (THIS IS MANDATORY FOR ONLY THOSE APPLYING FOR EVISA FOR BUSINESS) Reference in India * (IF YOU DO NOT HAVE ANY REFERENCE IN INDIA, THEN YOU CAN USE THE NAME OF THE HOTEL WHERE YOU PLAN TO STAY) Reference Name in India* Phone* Reference Name at Home Country* (THIS CAN BE YOUR FAMLIY OR FRIENDS IN YOUR HOME COUNTRY- COUNTRY OF WHICH YOU HOLD PASSPORT OF, for example, if you hold UK passport then you need to give reference in UK, if you hold Sweden passport then you need to give reference in Sweden.)

5 Phone* IMPORTANT NOTE:- 1. Please send us the Photo of your Passport (First Page- That has pass info and photo- This can be taken from your Mobile camera as well and be sent to us through ) 2. Your Digital Coloured Photograph with white background (This can be taken from your Mobile camera as well and be sent to us through ) 3. If applying for E-BUSINESS VISA then please ALSO send a Photo of your Business/Visiting Card. (This can be taken from your Mobile camera as well and be sent to us through )(ONLY FOR E-BUSINESS VISA APPLICATION) 4. If applying for E-MEDICAL VISA then please Send the scanned copy/pdf copy of the Invitation letter from the Indian Hospital (ONLY FOR E-MEDCIAL VISA APPLICATION) YOU CAN SEND US THE APPLICATION AND THE DOCUMENTS THROUGH TO : Info.no@blsinternational.net After we have received these will we contact you.