VISA APPLICATION FORM
CONSULATE GENERAL OF PAKISTAN STAPLE TH 12 EAST 65 STREET PHOTO NEW YORK NY 10065 HERE TEL: (212) 879 5800 FAX: (212) 517 6987 www.pakistanconsulateny.org
(IF ANY OF THE PARTICULARS FURNISHED ARE FOUND TO BE INCORRECT OR IF ANY INFORMATION IS FOUND TO HAVE BEEN WITHHELD THE VISA IS LIABLE TO BE CANCELLED AT ANY TIME)
FOR OFFICIAL USE ONLY 1 FULL NAME: FIRST MIDDLE LAST
2 SURNAME AT BIRTH IF DIFFERENT
3 PERMANENT ADDRESS
4 PRESENT ADDRESS
5 DATE OF BIRTH PLACE OF BIRTH
(DD/MMM/YYYY) (CITY, STATE, COUNTRY) 6 PHONE FAX EMAIL
) 7 PASSPORT NO. PASSPORT ISSUING COUNTRY
PLACE OF ISSUE DATE OF ISSUE DATE OF EXPIRY
(CITY, STATE, COUNTRY) (DD/MMM/YYYY) (DD/MMM/YYYY) 8 PRESENT NATIONALITY PREVIOUS NATIONALITY
9 FATHER’S NAME FATHER’S NATIONALITY
10 SPOUSE NAME SPOUSE NATIONALITY
11 HAVE YOU EVER BEEN A CITIZEN OF PAKISTAN PROFESSION OR OCCUPATION
12 TYPE OF VISA REQUIRED (PLEASE TICK) Tourist ___ Business ___ Student ___ Entry ___ Transit ___ Journalist ___ Conference ___ Employment ___ Transfer ___ Other ______
13 PERIOD OF VISA 15 Days ______Six Months ______One Year ______Five Year ______Other ______
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14 EXPECTED DATE OF DEPARTURE FROM USA EXPECTED DATE OF ARRIVAL IN PAKISTAN
15 PURPOSE OF JOURNEY PORT OF LANDING IN PAKISTAN
16 PROVINCE, TOWN, CITY OF DESTINATION IN PAKISTAN
17 ADDRESS IN PAKISTAN
18 NAME AND ADDRESSES OF PERSONS(S) WHO WILL FURNISH INFORMATION ABOUT THE APPLICANT, AND ALSO FURNISH FINANCIAL GUARANTEES FOR REPATRIATION IF REQUIRED
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19 WHETHER PREVIOUSLY RESIDING IN PAKISTAN AND IF SO PLACE OF RESIDENCE WITH DATES
20 WHETHER PERMISSION TO VISIT PAKISTAN HAS PREVIOUSLY BEEN REFUSED IF SO, WHEN?
21 WHETHER APPLICATION FOR GRANT OF VISA HAS BEEN SUBMITTED TO ANY OTHER PAKISTAN VISA ISSUING AUTHORITY?
22 I HEREBY UNDERTAKE THAT I SHALL UTILIZE MY VISIT TO PAKISTAN FOR THE PURPOSE FOR WHICH THE VISA HAS BEEN APPLIED.
DATE
Prepared By: Machine Readable Passport Section, Consulate General of Pakistan, New York
• Visa application form must filled in all respect. • Visa fee is US$ 124.00 (Money Order) for US Citizen only. • The issuance of visa is subject to the instructions of Government of Pakistan. • Visa fee is non-refundable, if visa application is processed. • If visa application is submitted through mail, self addressed prepaid envelope is mandatory. (USPS Express Mail only for urgent items)
Note: 5 year multiple entry visa will be issued to the Pakistan Origin US citizens on production of previous Pakistani passport or CNIC. For children born in the US, father’s Pakistani passport or CNIC is required.
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