APPENDIX
XXII
GOVERNMENT OF
MINISTRY OF HOME AFFAIRS
REQUEST FOR SPECIAL PERMIT FOR
PROTECTED AREAS
(Application to be submitted in duplicate)
|
Photograph |
1. Name of the
Applicant: ________________________________________________
(in capital letters with Surname underlined)
2. Father’s Name: ______________________________________________________
3. Honorifics: Mr./Miss/Mrs.
______________________________________________
(Score
out those not applicable)
4. Surname at birth, if
different: ____________________________________________
5. Place and date of Birth:
________________________________________________
(Your
Town and Country)
6. Nationality: (a) Present
________________________________________________
(b) Past, if different, till which date
______________________________
(c) Reason for
change________________________________________
7. Occupation: _________________________________________________________
(Give address of place of work if
employed)
8. Permanent Address:
__________________________________________________
9. Mailing address in
10. Reference (a) In country of
applicant _____________________________________
(b) In
11. Passport Details: No:
__________________________________________________
Issued by:
__________________________________________________
At______________________ valid up to
___________________
12.
Details of visa for
Issued by:____________________________________
Number_____________________________________
At
____________________________________
Valid up to
____________________________________
13. Places proposed to be
visited: ___________________________________________
14. Route intended to be
followed: ___________________________________________
15. Purpose of visit: ______________________________________________________
16. Likely date of visit:
____________________________________________________
17. Likely duration of visit:
_________________________________________________
18.
Is anyone accompanying the applicant?
If
so, give details: _____________________________________________________
19.
Arrangements for travel and accommodation that may have been made.
___________________________________________________________________
20. Details of previous visits
to
21.
Has/have He/She/They previously visited any Restricted / protected area in
or
If
so, please give details of the places visited and date of visit.
___________________________________________________________________
22.
Has any earlier request for permit been refused? If so, please furnish details.
___________________________________________________________________
-:DECLARATION:-
The information given above is correct
and complete to the best of my knowledge
Place_______________________
Date________________________ Signature of Applicant
NOTE :- 1. This application is to be sent to
the Ministry of Home Affairs,
2. It
is advisable to make the application at least eight weeks ahead of the
date of the proposed
visit.
3. Applicants outside
through the
nearest Indian Diplomatic or Consular