Please submit a Photo (Photo must be in JPG format): Maximum photo size limit is 50 KB
Particulars Fields to be filled
Surname
Given Name *
Male
Sex * Female
Transgender
Date of Birth Date Format * DD/MM/YYYY
Date of Birth (As per the passport)
Crew
Diplomat Exempted
Emergency Transit
Loss of Passport
Newly Born
OCI (Overseas Citizen of India)
Special Category *
Official Exempted
Other Exempted
Others (for General category)
PIO (Person of Indian Origin)
Refugee
TLP
Nationality *
Address in country where residing permanently (As per the
passport)
City *
Country *
Country where residing permanently
CISV Building and Kaizen Guest House, City Montessori
Address/Reference in India
School, LDA Colony, Kanpur Road
State * Uttar Pradesh
City/District * Lucknow
Pin Code * 226012
Passport No *
City Name:
Place of issue of passport*
Country Name:
Date of issue * (DD/MM/YYYY)
Valid till* (DD/MM/YYYY)
Visa No *
In case of CREW/TLP provide CREW/TLP Details
In case of OCI provide details of visa with “U” Sticker on visa
page issued by Indian Mission/Post and for PIO details of
PIO card to be entered
City:
Place of issue *
Country:
Date of issue* (DD/MM/YYYY)
Valid till * (DD/MM/YYYY)
Type of visa * Attendant Medical
Business Visa
Conference Visa
Diplomatic Visa
eBusiness Visa
eMedical Visa
Employment Visa
Entry Visa
eTourist Visa
Film Visa
Intern Visa
Journalist Visa
Long Term Visa
Medical Visa
Misc SP Permission
Missionary Visa
Mountaineering Visa
OCI
Official Visa
Pilgrim’s Visa
PIO Card Holder
Project Visa
Research or Training Visa
Student Visa
Temporary Landing Permit
Tourist Visa
Transit Visa
United Nations
Visit Visa
Arrived from Country *
Arrived from City * (City/ Place of above country)
Arrived from Place *
Date of Arrival in India * (DD/MM/YYYY)
Date of Arrival in Guest House * (DD/MM/YYYY)
Time of Arrival in Guest House (24 Hrs format)
Intended duration of stay in Guest House * (No. of Days)
Yes
Whether employed in India *
No
Purpose of Visit * (Choose appropriate options) Accompanying parents
Accompanying patients
Accompanying patient as doctor
Accompanying Spouse
Business
Diplomatic
Education
Employment
Internship
Joining Spouse
Journalism
Medical Treatment of Self
Meeting Friends / Relatives
Minor Child (either parent is Indian)
Official
Others
Seminar Conference in India
Studies
Surrogacy
Tourism
Inside India
Next Destination whether India or Outside India
Outside India
State:
Please fill if next destination is inside India City/District:
Place:
Country:
Please fill if next destination is outside India City:
Place:
Contact Phone No (In India)
Mobile No (In India)
Contact Phone No (Permanently residing Country)
Mobile No (Permanently residing Country)
Remarks (Endorsement on the visa page by the
Embassy/High commission of India)
Please attach one passport size photograph, copy of passport and the valid
Indian Visa page (all in JPEG format)
Visa type and abbreviation
A
bb
Type re
of visa vi
ati
on
Diplo
D
mat
Officia
O
l
UN
U
Officia
D
l
Transi
TR
t
Entry X
Touris
T
t
Emplo
E
yment
Projec
P
t
Stude
S
nt
Journa
J
list
Busine
B
ss
Missio
M
nary
Moun
tainee X
ring
Confer
ence/
Semin
C
ar/
Meeti
ng
Resea
R
rch
Medic M
al ED
Medic
M
al
ED
Atten
X
dant
Univer
U
sal
