CONSULATE GENERAL OF INDIA
Please attach  
JEDDAH two photo-  
(CONSULAR SECTION) graphs  
VISA APPLICATION FORM  
PART A  
 
1) NAME: (Mr/Mrs.)        
(In Block Capitals) Last Name First Name Middle name
a)     Previous Name  
        alias, if any
2) I)      Date of Birth:    
II)     Place of Birth:            
City State/Province Country
3) NATIONALITY:
I)      Present:     ii) Any other Nationality    
    Present or Previous
4) Passport Details:
I)     Passport No.     ii) Place   of   issue:    
iii)    Date of issue     iv) Valid upto    
5) Fathers Name and              
Nationality Father's Name Nationality
6) Spouse's Name and              
Nationality Spouse's Name Nationlity
7) Full address in Kingdom
P.O. Box
City       Zip  
Tel. No:     Office     Residence:
8) Profession:
I)     Govt/Private     II) Designation :      
III)   Name of Comp-     IV)  Address      
      any/Organisation      
 
V)   Salary/Monthly Income:      
9) Children included in Applicant's Passport :
Sr. No. Name Relationship Sex Date & Place Page no. of
              Of Birth the PPt.
                   
                   
                   
                   
                   
                   
                   
10) Has an Indian Visa been refused  previously if so, give        
details:        
11) Details of previous visit, if any Visa No.     Date:
Page No. of   Place of
Passport     Issue:
12) Number of entries desired
Single/Double/Triple/Multiple      
13) Countries from which entry into India will be made        
14) Period for which visa required        
15) Purpose of Journey, Transit/Business/Tourist/
Education/Any other        
16) Place(s) in India proposed to be visited          
17) Date of departure:     18)Date of arrivel in India    
19) Port of first entry to     20)Port of final departure    
India          from India    
21) Exit and Re-entry/Final exit Visa obtained on page No. (for Non-Saudi only)  
Part B
(Not to be filled by applicants for Tourist Visa)
1) Whether holding valid 'No Objection to return to India'
endorsement.                
2) Name and addresses of two references:
a)     In the country of applicant:-
I)
II)
b)     In India:
I)
II)
Part - C
Text Box: 1. ____________________________________ hereby undertake that I shall utlise 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 and found to be incorrect or if any information is found to have been withheld, the visa is liable to be cancelled at any time.
Place:        
Date         Signature of the Applicant
                     
FOR OFFICE USE ONLY
1) Number, Date and Type of Visa issued          
2) Amount of Visa fee received:      
3) Date on which passport returned to applicant