CONSULATE GENERAL OF INDIA
3 EAST 64TH STREET ( BET. MADISON AND FIFTH AVE.)
NEW YORK , NEW YORK 10021
TEL. (212) 774-0600, FAX:(212)570-9581
E-Mail: [email protected] (Our Website: https://indiacgny.org/ )

VISA APPLICATION FORM

�         Passport in original valid for a minimum of six months beyond date of intended departure from India should accompany visa applications.

�         PHOTOS: Please enclose Two passport size photographs with visa application.

• Please tender exact amount in the form of Money Order/ Bank Draft/Certified Check in the name of CONSULATE GENERAL OF INDIA or by CASH at the counter in bills. WE DO NOT ACCEPT PERSONAL CHECKS.
• Applications are accepted from 9:15 AM to 12:15PM on working days and serviced passports are delivered between 4:30 p.m. and 5:15 p.m.
• VALIDITY OF VISA STARTS FROM THE DATE OF ISSUE.
• THIS FORM MAY BE FREELY DUPLICATED .
• Please check instructions on filling up this form. Instructions can be obtained from the Consulate General of India, New York or from our website indiacgny.org

(Please print or type)

1. Full Name:_________________________________________________________

(First)                               (Middle)                     (Last)

2. Last name at birth(if different):________________________________________

3. Marital status: Married/Unmarried___________________________________

4. If married give maiden name:________________________________________

5. Date of Birth:___/___/___               6. Sex: Male__ Female__

                          mm dd yy

7. Place of birth:__________________________________________________________

8. Current nationality:_________________________________________________

9. Are you a permanent/long-term resident in USA? Yes____ No____

If yes, please attach copy of your Green-Card/Long-Term Visa status ( FOR NON-US PASSPORT HOLDERS ONLY)

10. Nationality at birth:____________________________________________________

11. Any other nationality held at present or in the past:_________________________

(Are you in possession of any other passport?)

12. Present Address:_____________________________________________________

_______________________________________________________________________

13. Phone:__________________________(Home)_______________________(Work)

14. Permanent Address:_________________________________________________

________________________________________________________________________

15. Profession:___________________________________________________________

16. Employer's Name and Address:__________________________________________

________________________________________________________________________

17. Passport Number:________________________________ 18. Valid Till:_________

19. Issued At:_______________________________________ 20. Issue Date:________

21. Father's/Husband's Name:______________________________________________

22. Nationality of Father/Husband:__________________________________________

23. Name and Nationality of Mother:________________________________________

24. Type of Visa required:____Tourist, ____Business, ____Student, ____Entry, ____Transit (short stop over while travelling to a third country), _____Journalist, ____Other

25. Period of Visa:____Days (For Transit with confirmed onward ticket only ), _____Six Months, _____One Year, ______Five years (for persons of Indian origin only, Six months each visit/Continuous stay ), ______ Ten years (for US citizens only)

26. Have you ever visited India before? Yes___ No___ If yes, give address where you stayed with dates:________________________________________________________

________________________________________________________________________

27. Has Indian visa or extension of same ever been refused to you previously? Yes__ No___ If yes, give details:_______________________________________________

________________________________________________________________________

28. Are you holding a valid "NO OBJECTION TO RETURN TO INDIA" endorsement?

Yes_____ No_____  

If yes, give details (for foreigners resident in India only) : __________________________

________________________________________________________________________

29. Purpose of Journey:____________________________________________________

30. Are you travelling on behalf of a company? Yes____ No____

31. If yes, give name and address of company:_________________________________

________________________________________________________________________

32. Expected date of departure from USA:____________ 33. Expected date of arrival in India:__________

34. Port of arrival in India:_________________________________________________

35. Are any children included in your passport accompanying you? Yes____ No_____

If yes, give details:

Full Name Date of Birth Sex

(a)_____________________________________________________________________

(b)_____________________________________________________________________

36. Name and address of two references:

(a) In India:_______________________________________________________

________________________________________________________________________

________________________________________________________________________

(b) In applicant's country:_________________________________________________

________________________________________________________________________

________________________________________________________________________

I, ______________________________________________, hereby undertake that I shall utilise my visit to India for the purpose for which the visa has been applied for and shall not, on arrival in India, try to obtain employment or set up business or extend my stay for any other purpose.

Declaration to be made by applicants seeking to stay in India for more than one year:

"I hereby undertake to undergo any medical test (s), including an AIDS test, within one month of my arrival in India. In case I test positive for AIDS, I agree to leave India".

Signature of applicant:______________________   Date:_______________ Place:_________