| “Please fill the Form in CAPITAL LETTERS”. |
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FORM OF APPLICATION TO BE FILLED IN BY ALIEN DESIRING
TO EXTEND HIS/HER STAY IN INDIA ( Excluding Pakistan and Bangladesh)
NOTE : If any of the particulars furnished below are found
to be incorrect or if any information is found to have been withheld,
the extension granted is liable to be canceled |
| 1. |
Name in capital ( as
in Passport) :
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| 2. |
Residential
address :
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| 3. |
Nationality
:
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| 4. |
Place & Date of Birth : |
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| 5. |
Profession & present occupation : |
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| 6. |
Purpose of visit to India. : |
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| 7. |
Passport particulars : |
8. |
Visa Particulars |
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i) Number |
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i) Number |
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ii)
Date of issue
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ii)
Date of issue
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iii)
Place of issue
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iii)
Place of issue
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iv) Valid till |
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iv) Valid till |
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| 9. |
Date & place of arrival in India : |
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| 10. |
Whether
resident in India previously :
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if so for what period. |
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| 11. |
Date of expiry of authorized stay : |
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| 12. |
Period for which extension is required : |
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| 13. |
Whether permission to extend stay in : |
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India has been granted / refused ,previously & if
so why. |
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| 14. |
Reason for extension of stay.
The :reason should be stated fully in details, failure to comply may
result in delay or refused of request. In case of missionaries the
exact nature of work on which engaged should also be stated. |
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| 15. |
Name and address of person in India : who furnished
financial guarantee for maintenance and repatriation on behalf of
the applicant when he entered in India. |
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Signature of the Applicant |
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Date
:
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