Download PDF - Bangladesh Deputy High Commission Karachi

Applicant's
Photograph
Measuring
45 mm x35mm
~.)
D. I. P Form-4(Free
of cost)
~
Government
of the People's Republic of Bangladesh
Department of Immigration & Passports
Machine Readable Visa Application Form
•
•
This Form Should Be Filled Up In 'Capital Letters'. Put (vi) In Appropriate Box.
Please Go Through The General Instructions Before Filling Up The Visa From.
•
Name of Office/ Bangladesh Mission :
PERSONAL
DETAILS
~~~_II_~_-
Ol. Full Name
(as in the passport)
First! Given Name (S)
Last! Surname
02. Permanent address:
Contact no:
03. Address in Bangladesh:
E-mail:
----------------------------Contact no:
/
04. Date of Birth:
DDI
_
/
E-mail:
D
05. Sex: Male
MM/YYYY
06. Place of Birth:
1 07 ..Present Nationality:
1
08. Nationality at Birth:
1
09. Occupation:
1'-
D
WidowerlWidow
10. Marital Status
Unmarried
D
Married
TRAVEL DOCUMENT
11. Passport No:
D
Female
D
Others
D
--'1
----'1
D
Divorced
DETAILS
12. Type of Passport
1
'------------
13. Place ofIssue:
15. Date of Expiry: _---1.__
14. Date of issue:
DDI
MM
I YYYY
--'-
_
DDI
M
M I YYYY
DDI
M
M I
\
I
16. Date of last visit to Bangladesh:
DDI
17. Last Visa No:
19. Place ofIssue:
M
M I
YYYY
----------~~of Issue:
.
~I 20. Date of Expiry:
YYYY
/L-_~/
D DIM
-
M I
_
YYYY
PAYMENT DETAILS
21. Name of the Bank and Branch:
_
22. Cheque/ Bank Transfer/ Chalanl Scroll No:
23. Amount deposited
(Taka/ US$)
1........
_
1
24. Date:
D
DI
M
M I
YYYY
NEW VISA
25. Purpose of Visit: DTourisU
Business
D Official D Diplomatic
Transit
DOthers
EmploymentD
D Study D Investment
D
----------(Please Specify)
26. Duration of Proposed Stay in Bangladesh:
27. Tentative Date of Arrival in Bangladesh: __
--I..I__
D DI M
28. Intended Number of Entries:
Single D
I<--
Re Entry
D
EXTENSION
29. Name of the FatherlMotherlSpouse/
30. Date of Arrival: __
in Bangladesh
0
--'-__
0 I M
_
M I YYYY
Multiple D
OF VISA
Other (Relation) :
~
_
31.Visa No:
32.Type ofVisa:
.•..
1
34. Date of Expiry: __
33. Date of issue
o
01 M
_
M I YYYY
M I YYYY
001
35. Place ofIssue:
1'--
_
M I YYYY
M
1====
1
36. Purpose of Extension of Visa:
37. Duration of Proposed Extension:
1__
38. Intended Number of Entries:
-----'
D
Single
Re Entry
D
Multiple
D
NO VISA REQUIRED FOR TRAVEL TO BANGLADESH
39. Father's name:
Nationality:
40. Mother's name:
Nationality: 1
41. Spouse's name:
Nationality: 1
=======
================
42. Date of Arrival in Bangladesh:
I
D 01 M
44. Date ofIssue:
I
43. Visa No:
M I YYYY
_
o
46. Place of issue:
1
01 M
_
IL....
_
45. Date of Expiry: ------
o
M I YYYY
1
_
47. Type of Visa:
_
DIM
MI
YYYY
1
1
48. Reason For Proposed NVR:
1
49. Amount ofInvestment (For Investor):
IL....
...:'
I
50. Name and Address of Company:
TRANSITION ARRIVAL VISA
51. Date of Arrival in Bangladesh:
.../...f__
D 01 M
52. Name of check post:
J-f
M I YYYY
53. Travelled by (Vessel'sl Flight/Vehicle Name & No):1
55. Purpose of Visit to Bangladesh:
I
1
L..---:--:--r========i
56.Duration of Proposed Stay:
----l
1
--.J
54. From:
I
CHECKLIST
Recommendation from concern Ministry/ Authority
D
D
Father's/ Husband's/Mother's
D
Work Permit
Bi- Lateral Agreement! Multilateral Agreement
D
D
D
D
Affidavit
Trade license of the sponsoring Company
D
Visa Copy
Passport copy, Last Visa & Last Arrival Page
Father's/ Husband's/Mother's
Passport Copy
N. O. C from Sri Lankan High Commission
Payment Slip
D
Over stay payment Slip
D
D
D
D
Marriage Certificate
Security Clearance/Security Certificate
Birth Certificate
Photo
D
D
Income Tax Certificate of the Company
D
D
TIN
TIN certificate of the company
Others
D
_
I, hereby, declare that statement given above is true and will not request to refund my paid visa fee even if my
application is declined.
Place --------Date
/
D D/MMI
/
Signature
YYYY
POLICE VERIFICATION
Memo No
,/
Date:
D
Information's are found:
,/
M
DI
Correct
M 1 YYYY
Incorrect
If not correct Reasons:
_
Signature and Seal of Inquiry Officer
Signature and Seal of Issuing Officer
FOR OFFICIAL USE
Reference No:
Date:
_
AJuountofFee:
Visa No
Date:
_
Date Expiry
Number of Entries
Recipient's
Date:
0 Extension 0 Re-
Signature:
Entry
o Multiple
_
\
Entries
0 NVR
Authorized Signature
Date & Seal

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