Online Visa Application
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visa from*
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IndianMission*
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Nationality* Select Nationality...
Date ofBirth *
(DD/MM/YYYY)
Email IDReenterEmail IDExpectedDate ofArrival*
(DD/MM/YYYY)
Visa Type* Select Visa Type....
AccessCode EnterAccessCode
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Online Visa Application
Indian Mission USASAN FRANCISCO
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Applicant Details Help in English
Surname (as shown in your Passport) Surname/Family Name (As in Passport)
Given Name (Complete as in Passport) * Given Name (exactly as in Passport)
Have you ever changed your name? If yes, click the box and givedetails.
If You have ever changed your Name Please tell us.
Sex* Select Sex
Date of Birth * 18/12/1983 Date of Birth as in Passport in DD/MM/YYYY format
Town/City of birth * Province/Town/City of birth
Country of birth * Select...... Country of birth
Citizenship/National Id No. * If not applicable Please Type NA
Religion *Select......
If Others .Please specify
Visible identification marks * Visible identification marks
Educational Qualification * Select...... Educational Qualification
Nationality * UNITED STATES OF AMERICA Nationality
Did you acquire Nationality by birth or by naturalization? * Did you acquire Nationality by birth or by naturalization?
Select One
Prev. Nationality Select Previous Nationality
If you have acquired Nationality by naturalization
specify Previous Nationality
Passport Details
Passport No. * Applicant's Passport Number
Place of Issue * Place of Issue
Date of Issue * (DD/MM/YYYY) In DD/MM/YYYY format
Date of Expiry * (DD/MM/YYYY) In DD/MM/YYYY format.Minimum Six Month Validity is
Required.
Any other valid Passport/Identity Certificate(IC) held,Yes / No If Yes Please give Details
Country of Issue Select...... Country of Issue
Passport/IC No. Passport No
Date of Issue (DD/MM/YYYY) Date of Issue
Place of Issue Place of Issue
Nationality mentioned therein Select...... Nationality described therein
* Mandatory Fields
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Applicant's Address Details HelpPresent Address
House No./Street*Applicant's Present
Address. Maximum 35
characters (Each Line)
Village/Town/City * Village/Town/City
State/Province/District*
State/Province/District
Country* Select Country Country
Postal/Zip Code* Postal Zip Code
Phone No. One Contact No is
Mandatory
Mobile No. Mobile no
Email Address [email protected]
Click Here for SameAddress
Click here for same
address
Permanent Address
House No./Street *Applicant's Permanent
Address(with
Postal/Zip Code)
Village/Town/City Village/Town/City
State/Province/District State/Province/District
Family Details
Father's Details
Name* Applicant's Father
Name
Nationality* UNITED STATES OF AMERICA Nationality of Father
Previous Nationality Select......Previous Nationality of
Father
Place of Birth* Place of birth
Country of Birth* Select...... Country of Birth
Mother's Details
Name* Applicant's Mother
Name
Nationality* UNITED STATES OF AMERICA Nationality of Mother
Previous Nationality Select...... Previous Nationality of
Mother
Place of Birth * Place of birth
Country of Birth * Select...... Country of Birth
Applicant's MaritalStatus *
Select One...Applicant´s Maritial
Status
Were your Grandfather/ Grandmother (paternal/maternal)Pakistan Nationals or Belong to Pakistan held area.
Were your Grandfather
/ Grandmother
(paternal/maternal)
Pakistan Nationals or
belong to Pakistan
held area? Yes / No
Yes No
If Yes, give details If Yes, give details
Profession / Occupation Details of Applicant
Present Occupation *Select...... If Others,please
specify
EmployerName/business*
Employer Name /
Business
Designation Designation
Address* Address
Phone Phone no
Past Occupation, ifany
Select...... Past Occupation, if any
Are/were you in a Military/SemiMilitary/Police/Security.Organization? Yes / No If yes,give details
Organisation Organization
Designation Designation
Rank Rank
Place of Posting Place of Posting
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Details of Visa Sought Help
Type of visa* BUSINESS VISASelect visatype you areapplying for
Name of the Company in India*Address*Phone*Email
Duration of Visa (in Months) * 0Duration ofvisit (inmonths)
No. of Entries * Select...... No of Entries
Purpose of Visit* Select...... Purpose ofvisit
Expected Date journey * 30/11/2016
(Visa validitywill startfrom theVisa IssueDate)
Port of Arrival in India *Port ofarrival inIndia
Expected Port of Exit from IndiaExpectedPort of Exitfrom India
Previous Visa/Currently valid Visa Details
Have you ever visited India before? Yes / No If Yes Pleasegive Details
Address*
Enter theaddress ofstay duringyour lastvisit
Cities previously visited in India *Cities inIndia visited(commaseparated)
Last Indian Visa No/Currently valid IndianVisa No. *
Last IndianVisa no /Currentlyvalid Visa no
Type of Visa * Select...... Type of Visa
Place of Issue * Place ofIssue
Date of Issue * (DD/MM/YYYY) Date ofIssue
Refuse
Has permission to visit or to extend stay in India previously been refused?
Yes / No
Details Yes/No
If so, when and by whom (Mention Control No. and date also)
If só, whenand bywhom(mentionControl noand date)
Other Information
Countries Visited in Last 10 years
Countriesvisited inlast 10 years(commaseparated)
SAARC Country Visit Details
Have you visited SAARC countries (except your own country) during last 3 years?
Yes / No
Have youvisited"South AsianAssociationfor RegionalCooperation"(SAARC)countries(except yourowncountry)during last 3years? Yes/No
Name of SAARC country * Year* No. of visits*Select...... Select......
Add Row
Reference
Reference Name in India*ReferenceName andAddress inIndia
Address*
Phone* Phone no
Reference Name in UNITED STATES OFAMERICA*
ReferenceName andAddress inUNITEDSTATES OFAMERICA
Address* Address
Phone* Phone no
To upload Photo click "Upload Image" .Click "Save and Continue" to directly
proceed without photo upload
PHOTO UPLOAD
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Confirm Details
The applicant is requested to verify theparticulars filled in the application Form.The
applicant may face legal action(including refusalto enter India or deportation) in case of
provision of wrong information.Please verify your Registration Details. If all details are correct please Press "Verified and
Continue".For any corrections press "Modify/Edit"
Please note down the Temporary Application ID:081823009TZISLB
Applicant Details
Surname Name EVAN Previous Surname Previous Name Sex MALE Marital Status SINGLE Birthdate 18/12/1983 Religion N Place of Birth FULLERTON
Country of Birth UNITED STATES OFAMERICA
Citizenship/National Id No. B9291029 Educational Qualification POST GRADUATE Visible Identification Marks N/A
Nationality UNITED STATES OFAMERICA
Nationality by BY BIRTH Previous Nationality Passport Details
Passport No 000000000 Issue Date 18/11/2016 Expiry Date 18/10/2026 Issue Place USA Country of Issue of Other Passport Other Passport Issue Place Other Passport No
Issue Date of Other Passport Nationality Described Therein Applicant's Address Details
Present Address DSF DDF DFSA
UNITED STATES OFAMERICA
Postal/Zip Code 95112 Present Phone No 890980980809 Mobile Email [email protected] Permanent Address SDFSD Family Details
Father Name SDFD
Father Nationality UNITED STATES OFAMERICA
Father Previous Nationality Father Place of Birth DSF
Father Country of Birth UNITED STATES OFAMERICA
Mother Name SDF
Mother Nationality UNITED STATES OFAMERICA
Mother Previous Nationality Mother Place of Birth DSFSD
Mother Country of Birth UNITED STATES OFAMERICA
Spouse Name Spouse Nationality Spouse Previous Nationality Spouse Place of Birth Spouse Country of Birth Grandparent details yes/no NO Grandparent Details Profession / Occupation Details of Applicant
Occupation BUSINESS PERSON Employee Designation SD Employer Name SDF Employer Address SDFSDF Employer Phone Previous Occupation Security Agency/Organisation Designation Posting Rank Details of Visa Sought
Visa Type BUSINESS VISA Visa Requirement Details Company Name DSADF Address ASDFAD Phone 987987987987987 Email
No of Entries SINGLE Duration 60 Journey Date 30/11/2016 Entry Point DSFSDF Exit Point Purpose BUSINESS Previous Visit Details
Old Visa Type Old Visa No Old Visa Issue Place Old Visa Issue Date Previous Visit Address Visited Cities Details Countries Visited DSFDF Refuse Details Reference
Name of Sponsor in India DFDS Address of Sponsor in India SDFDS Phone of Sponsor in India 98798798798798
Name of Sponsor in UNITEDSTATES OF AMERICA SDFD
Address of Sponsor in UNITEDSTATES OF AMERICA DSFSDF
Phone of Sponsor in UNITEDSTATES OF AMERICA 809808089
Modify/Edit Verified and Continue