visa application form - Embassy of India, Algiers, Algeria

Toutes les cases du formulaire doivent être remplis correctement et en lettres majuscules, pour
éviter le rejet du dossier.
PHOTO
VISA APPLICATION FORM
DEMANDE DE VISA
PART – A [PARTIE – A]
[PART FILLED BY ALL APPLICANTS FOR VISA]
[DOIT ETRE REMPLIE PAR TOUS DEMANDEURS DE VISA]
NAME [NOM]
FIRST NAME [PRENOM]
MIDDLE NAME [AUTRE PRENOM]
[Monsieur]…………………………………………………………………………………
[Mme]……………………………………………………………………………………..
[Mlle]………………………………………………………………………………………
OFFICIAL USE
Previous names if any
[Noms précédents]
Father’s name
[Prenom de père]
Husband’s name
[Nom de l`époux]
Place of Birth
[lieu de naissance]
City [Ville]
State [Etat]
Date of Birth [Date de naissance]
Day [Jour]
Month [Mois]
Country [Pays]
Visa to be granted
Year [Annee]
FS (CONS)
Address [Addresse]
Phone No [Numero de Telephone]
Profession [profession]
Field of present employment [Domaine de l`emploi actuel]
Passport No [Numero Passport]
issued by [Deliverer par]
Issued on [delivrer le]
sticker serial No and
period granted
Expiring on [Expire le]
Children included in the applicant’s passport
Name
Place and Date of birth
Sex
Nom
[lieu et date de naissance]
[sexe]
[Enfants inclus dans le passeport du demandeur]
Relations
Identification mark if any
[Lieu de parente]
[Signe d`identification]
…………………….
…………………….
……………………..
Present nationality
Nationalité actuelle
any other nationality [present or previous]
Autre nationalite, [actuelle ou précédente]
Whether visa has been refused previously if so, give details.
Le visa a-t-il été refuse auparavant si oui, donnez les détails.
Details of previous visits to India, if any. [Détails sur la visite précédente en Inde]
Number of entries [ ] Single
Nombres d`entrées [Simple]
[ ] Double
[Double]
[ ] Triple
[triple]
Countries from which entry into India will be made
[Les pays a partir des quels vous entrez en Inde]
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[ ] Multiple
[Multiple]
Period for which visa is required
[Periode pour laquelle le visa
est demande] .............................
Purpose of Journey [ ] Transit
[ ] Tourist
[ ] Business [ ]
[But du séjour]
[Tourisme]
Education
places in India
to be visited [Endroits
a visiter en Inde]
[Affaire]
.........................................
Approximate date of arrival in India
[Date approximative d`arrive en inde]
approximate date of departure from India
[Date approximative du départ d’Inde]
Port of first entry to India
[Port d‘entrée en Inde]
port of final departure from India
[Port final de départ d`Inde]
PART – B [PARTIE – B]
TO BE FILLED BY APPLICANTS FOR BUSINESS VISAS
[doit être remplie par les demandeurs de visas D’affaire]
Names and addresses of two referees
In the country of Applicants
[Dans le pays du demandeur]
[Noms et addresses des deux references]
[1]……………………………………...............................................
.……………………………………..............................................
In India, [en Inde]
[2]……………………………………...............................................
........................……………………………………......................
PART – C- [Partie – C]
I………………………………………………...herby undertake that i shall utilise my visit to India for the
purpose for which visa has been applied and shall not on arrival in India try to obtain employment or set up
business or extend my stay for any other purpose. I fully understand that if any of the particulars furnished
above are found to be incorrect or if any information n is found to have been withheld, the visa is liable to be
cancelled at any time.
Je soussigné,…………………………...........................m`engage a n`utiliser ma visite en inde que pour le but
dans lequel mon visa a été demande et n`essayerai pas a mon arrivée en Inde d`obtenir un emploi, ou menter
une affaire, ou prolonger mon séjour dans n`importe quel autre but. Je comprends pleinement que si n`importe
quelle information est fausse, le visa doit être annule a tout moment.
Date le………………………….[Signature of applicants / Signature du demandeur] .............................................
FOR OFFICIAL USE ONLY
No. Date and type of visa issued…………………………………………………………..........................
Amount of visa fee received………………………………………………………………………………
Date on which passport returned to applicant…………………………………………………………….
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