0110234YUE99

APPLICATION FORM
( Visa Extension )
0110234YUE99
Application ID No. 0110234YUE99 Final Submission Date Mon Oct 02 13:38:36 IST 2023
FOR OFFICE USE ONLY
Reg. No. B 0 0 1 B G D 2 0 2 3
Personal Details
Surname HASAN
Given Name ARIF Paste your
Sex Male Date of Birth 04/01/2001 Height (in cm) 160 Recent passport size
Age as on today Year(s) 22 Month(s) 8 Day(s) 29 photograph here
Place of Birth MOULVIBAZAR,MOULVIBAZAR,BANGLADESH
Father's Name ABID ALI
Mother's Name SAMINA BIBI
Spouse's Name
Religion ISLAM Any Identification mark(s) preferably NILL
visible
Present nationality BANGLADESH 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 ITA TEA GARDEN, WARD NO-08, RAJNAGAR, KARIMPUR-3235, MOULVIBAZAR
City MOULVIBAZAR Country BANGLADESH
Address intended for longer stay in India (Registration)

Address HOTEL PEACE POINT, 8681 DESHBANDHU GUPTA ROAD, PAHARGANJ
City/ District DELHI State DELHI
Pin Code 110055
Phone Number Mobile Number 9891296202
Any Other Address in India
Address
City/ District State
Pin Code
Phone Number Mobile Number
Email/Occupation/Profession Details
E-Mail Id [email protected]
Profession/Occupation STUDENT
Passport Details
Passport Number A00055676 Place of Issue BANGLADESH, DHAKA
Date of Issue 26/04/2021 Expiry Date 25/04/2031
Visa Details
Visa Number VL9380393 Place of Issue BANGLADESH, HCI SYLHET
Date of Issue 04/07/2023 Expiry Date 03/10/2023
Valid For Single Entry Visa Type TOURIST VISA
Special endorsement, if any
Organization/Company/Institute/Hospital Details
Name
Address
Page 1 of 3
0110234YUE99
Application ID No. 0110234YUE99
State City
Telephone Number Email ID
Employer EPFO ID Establishment ID
Arrival Details
Place of embarkation/boarding for India DHAKA,DHAKA,BANGLADESH
Date of arrival in India 30/09/2023
Place of disembarkation/arrival in India DELHI
Mode of Journey Air Flight/ Ship/ Bus/ Train No. AI238
Purpose of visit to India Tourism
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 ABID ALI Relationship FEATHER
Address ITA TEA GARDEN, WARD NO-08, RAJNAGAR, City MOULVIBAZAR
KARIMPUR-3235, MOULVIBAZAR
Country BANGLADESH Phone Number 01705633855
Category Others
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? NO Current
Registration No.
Current Extension Details

Have you got extended visa in current visit in current locality NO Current
FRRO/FRO? Extension No.
Visa Extension Details

Whether previously in India? NO
Whether permission to stay in India has been previously refused? NO
Whether permission to extend stay in India has been previously granted? NO
Period of Extension requried Year(s) Month(s) Day(s) 15
Reason for extension I WANT TO WATCH ICC CRICKET WORLD CUP 2023 BANGLADESH CRICKET TEAM MATCH VS NEW
ZEALAND,
In case of Missionary - Nature of work
Signature of the Applicant

Date_ _ _ _ _ _ _ _ _ _ _ _ _
Page 2 of 3
0110234YUE99
Application ID No. 0110234YUE99
List of mandatory and non mandatory documents
Mandatory Documents.
1. Photo : Applicant's Photo
2. Residence proof : Residence proof i.e. updated form 'C' generated by hotel/ lodge or Registered / Notarized Lease Deed or Utility Bill copy along with copy of photo-ID of landlord with
declaration.
3. Visa : Copy of latest Indian visa

4. Passport : Bio-data page of passport
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
There is no need to submit hard copy to concerned

FRRO/FRO
Page 3 of 3

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APPLICATION FORM

FOR OFFICE USE ONLY

Present nationality BANGLADESH Previous nationality

Whether person of Indian Origin NO

Address of last residence (Outside India)

Address intended for longer stay in India (Registration)

Previous Registration Details in India

Military service details

Current Registration Details

Current Extension Details

Visa Extension Details

Signature of the Applicant

List of mandatory and non mandatory documents

3. Visa : Copy of latest Indian visa

Registration office address

Office Name : FRRO NEW DELHI

Office opening time: 9.30 closing time: 18.00

There is no need to submit hard copy to concerned

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