BGDR28835015MD520101
Asst High Commission of India Rajshahi
House No-284, Sector-2,Housing Estate
Uposhahar,Rajshahi
Paste your unsigned recent color photograph.
Size: 2” X 2”
www.ahcirajshahi.org
00880721861213
Visa Application Form
Signature
BGDR28835015
A. Personal Particulars (As in Passport)
Surname (As in Passport)
SHAHIDULLAH
Given Nam e (As in Passport) MD
Previous/other Name if any
Male
01-JAN-1952
CHAPAINAWABGANJ
19527026608152915
N/A
BANGLADESH
Sex
Web Registration Date : 13-MAR-2015
Application Id :BGDR28835015
Date of birth
Place of Birth Town/City
Citizenship /National ID No
Visible identification marks
Current Nationality
Marital Status
Religion
Country of Birth
Educational Qualification
Married
ISLAM
BANGLADESH
HIGHER SECONDARY
Nationality by Birth/ Naturalization
BY BIRTH
Date of issue ( dd/mm/yyyy )
10-FEB-2015
09-FEB-2020
Any Other Previous/Past Nationality
B. Passport Details
BE0493305
CHAPAINAWABGANJ
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
BODUMIAPARA, RAJARAMPUR
CHAPAINAWABGANJ SADAR
CHAPAINAWABGANJ, BANGLADESH 6300
Phone No
Mobile /Cell No
01719933808
Email address
Permanent BODUMIAPARA, RAJARAMPUR
Address
CHAPAINAWABGANJ SADAR
CHAPAINAWABGANJ
D. Family Details
Relation
Name
Nationality
Prev. Nationality
Place/Country of Birth
Father’s
ELIYES UDDIN BISWAS
BANGLADESH
CHAPAINAWABGANJ
BANGLADESH
Mother’s
SHOHOR BANU
BANGLADESH
CHAPAINAWABGANJ
BANGLADESH
Spouse
MST NASERA BANU
BANGLADESH
CHAPAINAWABGANJ
BANGLADESH
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO
E. Details of Visa Sought
TOURIST VISA
(Month) 12 Month
BY ROAD MAHADIPUR
Type Of Visa Required
Period of Visa
Port Of Arrival
(Visa shall be valid from the Date
House No-284, Sector-2,Housing Estate
Uposhahar,Rajshahi
Paste your unsigned recent color photograph.
Size: 2” X 2”
www.ahcirajshahi.org
00880721861213
Visa Application Form
Signature
BGDR28835015
A. Personal Particulars (As in Passport)
Surname (As in Passport)
SHAHIDULLAH
Given Nam e (As in Passport) MD
Previous/other Name if any
Male
01-JAN-1952
CHAPAINAWABGANJ
19527026608152915
N/A
BANGLADESH
Sex
Web Registration Date : 13-MAR-2015
Application Id :BGDR28835015
Date of birth
Place of Birth Town/City
Citizenship /National ID No
Visible identification marks
Current Nationality
Marital Status
Religion
Country of Birth
Educational Qualification
Married
ISLAM
BANGLADESH
HIGHER SECONDARY
Nationality by Birth/ Naturalization
BY BIRTH
Date of issue ( dd/mm/yyyy )
10-FEB-2015
09-FEB-2020
Any Other Previous/Past Nationality
B. Passport Details
BE0493305
CHAPAINAWABGANJ
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
BODUMIAPARA, RAJARAMPUR
CHAPAINAWABGANJ SADAR
CHAPAINAWABGANJ, BANGLADESH 6300
Phone No
Mobile /Cell No
01719933808
Email address
Permanent BODUMIAPARA, RAJARAMPUR
Address
CHAPAINAWABGANJ SADAR
CHAPAINAWABGANJ
D. Family Details
Relation
Name
Nationality
Prev. Nationality
Place/Country of Birth
Father’s
ELIYES UDDIN BISWAS
BANGLADESH
CHAPAINAWABGANJ
BANGLADESH
Mother’s
SHOHOR BANU
BANGLADESH
CHAPAINAWABGANJ
BANGLADESH
Spouse
MST NASERA BANU
BANGLADESH
CHAPAINAWABGANJ
BANGLADESH
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO
E. Details of Visa Sought
TOURIST VISA
(Month) 12 Month
BY ROAD MAHADIPUR
Type Of Visa Required
Period of Visa
Port Of Arrival
(Visa shall be valid from the Date