EMBASSY OF INDIA BUITENRUSTWEG 2, 2517 KD ,THE HAGUE THE NETHERLANDS Paste your unsigned recent color photograph. Size: 2” X 2” www.indianembassy.nl 0031 70 3469771 Visa Application Form Signature NLDT00404614 A. Personal Particulars (As in Passport) Surname (As in Passport) RAMCHARAN Given Nam e (As in Passport) NAVJINDER Previous/other Name if any Web Registration Date : 17-JAN-2014 Web File Number :NLDT00404614 Sex Date of birth Place of Birth Town/City Citizenship /National ID No Visible identification marks Current Nationality Male 25-OCT-1993 ROTTERDAM 214158421 NO NETHERLANDS Marital Status Religion Country of Birth Educational Qualification Un-Married SIKH NETHERLANDS GRADUATE Nationality by Birth/ Naturalization BY BIRTH Date of issue ( dd/mm/yyyy ) 06-DEC-2013 06-DEC-2018 Any Other Previous/Past Nationality B. Passport Details NXKJDRH82 CAPELLE AD IJSSEL Passport No. Place of issue Date of expiry (dd/mm/yyyy) Any other Passport/Identity Certificate held (if yes ,please fill in the following) NO Country of issue Place of issue Passport/IC No Date of issue(dd/mm/yyyy) Nationality/status C. Applicant’s Contact Details Present address BACHSTRAAT 43 CAPELLE AAN DEN IJSSEL ZUID HOLLAND, NETHERLANDS 2901 JX Phone No 0104851310 0641904406 Email address [email protected] Mobile /Cell No Permanent BACHSTRAAT 43 Address CAPELLE AAN DEN IJSSEL ZUID HOLLAND D. Family Details Relation Name Nationality Prev. Nationality Place/Country of Birth Father’s BIKKAR NETHERLANDS INDIA RASULPUR INDIA Mother’s KAUR NETHERLANDS INDIA JAMIATGARH MANJLE INDIA Spouse Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO E. Details of Visa Sought (Visa shall be valid from the Date of Issue and not from the Date of Journey) TOURIST VISA (Month) 3 Month AIRPORT NEW DELHI Type Of Visa Required Period of Visa Port Of Arrival NAVJINDER RAMCHARAN No of Entries Expected Date of Journey Port of Exit Single 09-FEB-2014 AIRPORT NEW DELHI Required Detail of TOURIST VISA DELHI PUNJAB Purpose of Visit : TOURISM F. Previous Visit Details Have You Ever visited India ? Address where You stayed in India YES VPO KANGNA BET TEH. BALACHOUR, DISSTT. NAWANSHAHR Cities in India Visited DELHI NAWANSHAHR Type of Visa TOURIST VISA Visa Number UNKNOWN Visa Issued Place DEN HAAG Date of Issue 01-FEB-2013 Countries visited in last 10 years INDIA Have you been refused an Indian Visa or extension of the same previously or deported from India ? If yes above mention when and by whom with control No/Date G. Profession/Occupation Details Present Occupation WORKER Designation/Rank SALES EMPLOYEE Employer name/business AKTIESPORT BV Employer Address ZWART JANSTRAAT 35 Phone Number 0102439294 Past occupation if any Are/have you worked with Armed forces/ Police/ Para Military forces ? NO Organization Designation Place of Posting Rank H. Address of Place of Stay / Hotel Place/Hotel Name Address of Place / Hotel I. Details of Two Reference In India Nam e KASHMIR KAUR Address VPO KANGNA BET TEH. BALACHOUR Phone 00919815025175 Number In BERRY KOSTER State Phone No. NETHERLANDS VAN BEETHOVENLAAN 111 CAPELLE AAN DEN IJSSEL 0614536492 J. DECLARATION: a. b. c. d. I do not hold any other passport(s) other than those detailed above. I have read and understood all the conditions for the visit to India and I am willing and able to abide fully by them. I declare that the information given in the form is complete and correct and the visit to India will be undertaken for the purpose indicated in the application. I understand that in case the information provided in the form is found to be incorrect, I will be liable for denial of visit/ entry or deportation and/ or other penalties during the visit as provided by Indian law. 17-JAN-2014 Date :………………………. ..…………………………………… Applicant’s signature (as in Passport) Web File Number :NLDT00404614 Places to be Visited
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