Indian e-Visa

Visa Details Form

Please note down the Temporary Application ID : 12051345U4JKWKB

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Details of Visa Sought

Type of Visa

e-Visa

Visa Service

e-Medical Visa

Places to be visited

Please enter places to be visited

Duration of Visa

60 Days

Duration of visa is 60 days from date of arrival

No. of Entries

Triple

No of Entries

Port of Arrival in India

Port of arrival in India

Expected Port of Exit from India

Previous Visa/Currently valid Visa Details

Have you ever visited India before?

Yes / No

If Yes Please give Details

Address

Enter the address of stay during your last visit

Cities previously visited in India

Cities in India visited (comma separated)

Last Indian Visa No/Currently valid Indian Visa No.

Last Indian Visa no / Currently valid Visa no

Type of Visa

Place of Issue

Date of Issue

Date of Issue in (DD/MM/YYYY) format

Has permission to visit or to extend stay in India previously been refused? Yes No

Refuse Details Yes /No

If so, when and by whom (Mention Control No. and date also)

If so, when and by whom (mention Control no and date)

Other Information

Countries Visited in Last 10 years

Countries visited in last 10 years (comma separated)

SAARC Country Visit Details

Have you visited SAARC countries (except your own country) during last 3 years? Yes No

Have you visited "South Asian Association for Regional Cooperation" (SAARC) countries (except your own country) during last 3 years? Yes /No

Name of SAARC country

Year

No. of visits

Reference

Reference Name in India

Reference Name and Address in India

Address

Phone

Phone no

Reference Name in UNITED KINGDOM

Please mention one contact details in Home Country to be contacted in case of emergency

Address

Phone

Phone no