G3 Global Services Tel: 877.898.1203 Fax: 866.611.6960 ATJ@g3visas.com ATJ India Please send the following to G3: Complete this cover sheet and the enclosed Indian Visa Questionnaire (one per guest) and email it to G3 at ATJ@g3visas.com, along with scans of the information/photo page of your valid passport and your driver s license. A G3 associate will complete your application online and email you a PDF of the application to print, sign, and include in your package. You may also opt to fax your questionnaire to G3 and receive your completed application by US Mail. Please allow three business days for your application to be completed and emailed to you. The completed online application must be returned to you before the passport, photographs, signed application, payment and instruction sheet are sent to G3. Your original valid signed passport. It must have at least two blank pages marked Visas side by side and more than six months before expiry. Two passport-style (2 x2 ) photograph taken within the last 6 months (must be on photo paper and have a plain white background). Do not wear glasses in the photographs. Copy of your state-issued driver s license or copies of two major utility bills in your name listing a street address, not a PO box. Copy of your purchased/confirmed international flight itinerary. Additional documentation may be required; a final list of requirements will be sent with your completed visa application. This cover sheet with all fields completed. Only one cover sheet is required per family. Contact and Shipping Information: Provide a street address for FedEx delivery - no P.O. boxes. Name Address City State Zip Daytime Telephone Mobile Telephone Email We will email you the FedEx tracking number for your return shipment. Shipping Fees: All return shipping fees are included. Your passport will be returned via Federal Express. FedEx delivers to residential addresses with no signature required; please note below if you require a signature release for your package. (Redelivery fees may apply.) Travel Information: Date of US Departure / / Date Passport Needed / / Names of additional travelers in your family group: ATJ Trip Coordinator Special Notes: Delivery instructions, additional services, etc. Fees: Payment includes Embassy fees, G3 service fees, and return shipping via Federal Express. Requirements and fees are subject to change without notice. Visas will be valid for 5-10 years from the date of issue. Processing times begin when G3 receives hard copy documents. Available Services: FEE # Travelers TOTAL India Visa, Multiple Entry X = 21 Business Day Processing India Visa, Multiple Entry X = 15 Business Day Processing Passport Protection Plan X = (Optional. If your valid passport is lost or damaged, G3 will replace it with no service fees.) Payment Information: All fees are payable to G3 by: Credit Card: American Express, Visa, or MasterCard Check or Money Order payable to G3 Global Services For Payment Via Credit Card: I authorize G3 to charge the amount of $ plus a 5% convenience fee to my credit card. Visa/MasterCard: - - - Exp. Date: / Security Code: American Express: - - Exp. Date: / Security Code: Name as it appears on the card Billing Address City State Zip OR Signature G3 Global Services, LLC acts on the behalf of the client, and takes no responsibility for the services rendered by Travel Agents, Consulates or Embassies in connection with granting of visas. G3 Global Services, LLC takes no responsibility for delays or loss of passports as may occur through above services or by the U.S. mail. Damage compensation is not available. 11/17
This completed questionnaire. You may save your answers on this file and email directly to G3. All questions must be answered in order for G3 to complete your application accurately. A scan of the information/photo page of your valid passport. A scan of your Driver s License. Your completed Visa Order Form. If you have previously visited India, provide a scan of your most recent Indian visa. This document is for G3 use only and is not the official application. Your completed application will be emailed to you within three business days. YOUR PERSONAL INFORMATION: Last Name: First Name: Middle Name: If your name has legally changed, list your previous name(s) here: Sex: Male Female Date of Birth: / / Place of Birth: City: State: Country of Birth: USA Other: National ID Number (Non-US Citizens only): Religion Visible Identification Marks (scars, tattoos): Highest Educational Level Obtained: High School Diploma Some High School (did not complete 10th grade) Bachelors Degree Some High School (completed 10th grade) Masters Degree or Doctorate Child Younger than High School Age Professional Degree (law, medical, or other professional degree) Other: Country of Citizenship: USA Other: Citizenship Acquired By: Birth Naturalization Previous Citizenship: None Other: YOUR PASSPORT DETAILS: Passport Number: Issuing Authority/Place of Issue: US Department of State Other: Date of Issue: / / Date of Expiry: / / 1
Do you hold any other valid passports? No Yes, details below: Passport Number: Issuing Authority/Place of Issue: US Department of State Other: Date of Issue: / / Date of Expiry: / / YOUR CONTACT INFORMATION: Home Address: City: State: Zip Code: This address must match the address on your Driver s License and must be a street address - NO PO BOXES. If a PO Box address is shown on your Driver s License, you must submit a gas, water, or electric bill in your name with a street address. Is this your permanent address? Yes No, permanent address listed below: Permanent Address: Non-US citizens must list their most recent address in their home country here. City: State: Zip Code: Country: Home Telephone: Mobile Telephone: Home Email: YOUR FAMILY INFORMATION: Your Father s Full Name (even if deceased): Father s Place of Birth: City: State: Father s Country of Birth: USA Other: Father s Citizenship: USA Other: Previous Citizenship, if any: Your Mother s Full Name (even if deceased): Mother s Place of Birth: City: State: Mother s Country of Birth: USA Other: Mother s Citizenship: USA Other: Previous Citizenship, if any: Your Marital Status: Married Unmarried (including single, divorced, or widowed) If married, complete the following: Your Spouse s Full Name: Spouse s Citizenship: USA Other: Previous Citizenship, if any: Spouse s Place of Birth: City: State: Spouse s Country of Birth: USA Other: Were any of your grandparents citizens or residents of Pakistan? No Yes (provide details below) 2
YOUR WORK INFORMATION: Your Occupation: Your Position: Name of Employer or School: Work Address: City: State: Zip Code: Work Telephone: Work Email: Previous Occupation, if any: Have you ever been a member of the military? No Yes (complete details below) Country and Branch of Service (i.e. US Navy): Specialization: Highest Rank Obtained: Service Location: City: State: Country: YOUR TRAVEL TO : Type of Visa Required: Tourist Conference, valid 3 months Business Employment Flight Crew Other: For visas other than tourist or conference, select the requested validity of the visa: 1 Year 5 Years 10 Years Validity is granted at consular discretion; a shorter validity may be issued without refund. Are you applying for a new visa, or to transfer a valid visa from a cancelled passport to a new passport? New Visa Visa Transfer Expected Date of Arrival to India: / / Arrival City in India: Exit City from India: Other Indian Cities to be Visited: Have you previously visited India? No Yes, details of most recent visit below: Address of Hotel or Residence: Cities Visited in India: Indian Visa Number: Issued By (consulate location, i.e. Washington, DC): Type of Visa: Tourist Conference Business Employment Flight Crew Other: When was your visa issued? / / 3
Have you ever been refused an Indian visa? No Yes, details below: Please list the countries you have visited in the last ten years: YOUR REFERENCE IN : Tourists may list a reference at a hotel or tour agency in India. Business applicants must list a contact at the Indian company to be visited; Flight Crew applicants may use a reference at a handler or FBO. Name of Person: (not required for tourists listing a hotel or tour agency) Company Name: Telephone: Email: YOUR REFERENCE IN USA: Your US reference may be someone who knows you personally or professionally, but may not be someone who lives with you. Name of Person: Company Name (if applicable): City: State: Zip Code: Telephone: Email: 4 Revised 6/5/2012