Please paste your passport size photo not older than Six months

VISA APPLICATION FORM 請貼 2 吋彩色照 (Please complete the form using CAPITAL letters 請用正楷大寫字體) 片(6 個月內) 1. VISA PARTICULARS:

A. TYPE OF VISA REQUIRED (Please Select) :簽證類別(請勾選) Tourist 觀光 Business 商務 Conference 會議 Student 學生 Employment 工作 *Journalist 記者 Others(Please Specify)其它請註明 ______B. PERIOD OF VISA (Please Specify) 簽證效期， 請註明______C. EXPECTED DATE OF ARRIVAL IN INDIA 抵達印度日期: ______D. REQUIRED ENTRY/ENTRIES 入境次數: Single 單次 Double 兩次 Multiple 多次 E. PLACES TO BE VISITED 參觀地點: ______2. PERSONAL PARTICULARS:

A. FULL NAME 全名: (As in passport) 同護照英文姓名

中文）姓 中文）名 B. SECOND NAME: (Current or previous, if applicable)

C. DATE OF BIRTH 出生日: Year Month Date

D. SEX: 性別 (Please Select 請勾選) Male 男性 Female 女性

E. BIRTH PLACE 出生地 : Country 國家______City 市 & State 省______

F. PRESENT NATIONALITY 現有國籍 (I) ______(II) ______

PREVIOUS NATIONALITY 舊國籍 (I) ______(II) ______G. NAME OF 父親姓名 Father OR 配偶姓名 Spouse: ______NATIONALITY 國籍: ______3. PASSPORT PARTICULARS

(A) NUMBER(護照號碼)□□□□□□□□□□□□

(B) DATE OF ISSUE (護照簽發日)□□□□□□□□ DATE OF EXPIRY(護照到期日)□□□□□□□□ (C) PLACE OF ISSUE (護照簽發地) : Country 國家______City 市 & State 省______4. DETAILS OF PREVIOUS VISITS TO INDIA:

(A) HAVE YOU VISITED INDIA 是否曾經去過印度: Never 從來沒有 once 一次 more than once 一次以上 (B) IF YES, ARRIVAL DATE IN INDIA ON THE LAST VISIT 如有,上次入境日期: □□□□□□□□ DEPARTURE DATE FROM INDIA 離境日期: □□□□□□□□ (C) HAS INDIAN VISA OR EXTENSION OF THE SAME EVER BEEN REFUSED TO YOU PREVIOUSLY 是否曾經被拒發印度簽證或延簽: YES 是 NO 否 If yes, please provide details: 如是, 請詳述 ______-______5. EMPLOYMENT PARTICULARS:

(A) PROFESSION:(Please Select/specify)目前職業(請勾選) Private sector 私人公司 Student 學生 Government 公務 *Journalist 記者 Unemployed 無業 Armed forces 軍職 Free Lance 自由業(Please specify) 請詳述 ______(B) DESIGNATION WITH NAME, ADDRESS AND POSTAL CODE OF COMPANY/SCHOOL/TEMPLE 公司/學校/寺廟名稱,地址, 郵遞區號和職稱______

______*Please note: Journalists, irrespective of objective of the visit, are required to apply for Journalist visa only 注意：記者無論參訪目的為何，都須申請記者簽證

請以英文填滿每一欄

6. CONTACT DETAILS:

(A) PRESENT ADDRESS (現居地址+郵遞區號):______(B) PERMANENT ADDRESS 永久地址(If different from above) (若與現居地址不同): ______(C) TELEPHONE(電話)Home 住家______Office 公司______Mobile (手機)______Email 電郵: ______

IMPORTANT NOTICE: A PERSON WHO HOLDS OR HELD OR WHOSE PARENTS OR PATERNAL OR MATERNAL GRANDPARENTS HELD PAKISTANI NATIONALITY AT ANY TIME, NEED TO FILL UP AN ADDITIONAL FORM. 請注意：若持有或曾經持有巴基斯坦護照，或父母或祖父母 / 外祖父母曾持有巴基斯坦護照，須填寫附加的表格

i. I, (Full name as in Passport)______hereby state that I am a resident of and in the last one year my continuous stay outside Taiwan doesn’t exceed 6 months. I shall utilize my visit to India for the purpose for which the visa has been applied for. There should be a gap of at least 2 months between visits on a Tourist visa. 本人（同護照英文姓名）＿特此聲明為台灣居民，過去一年離台期間不超過六個月．本人將遵守所核發的印度簽證類別之 規定．持觀光簽證每次入境印度至少有二個月的差距． ii. I understand that on a Tourist visa I am not allowed to attend any Conference or business meeting and I can not undertake employment on a Business visa. 本人瞭解持觀光簽證不可參加任何研討會或商務會議，持商務簽證不可任職工作． iii. I understand that the visa will not be valid for Restricted/Protected/Cantonment areas. 本人瞭解簽證在限制區，保護區和軍事地區是無效的． iv. I understand that if I violate above, I will have to face legal consequences including possible deportation and denial of visa in future. 本人瞭解若有違反上述規定，須面臨法律制裁包括可能被驅逐出境和未來簽證申請被拒發等處分． v. I.T.A. has the right to refuse visa without assigning any reason whatsoever. In case visa is denied or I withdraw visa application, visa fee is not refundable. 印度台北協會有權在無任何理由情況下拒發簽證．若簽證 被拒發或本人撤回簽證申請，簽證費用不予退還．

Signature of Applicant (同護照本人親筆簽名)______

Date(申請日期)______

Place(申請地點)______

Address: Suite 2012, TWTC International Trade Building, NO. 333, ROAD, SECTION 1, , TAIWAN 110 Tel: 886-2-2757-6112/3 Fax: 886-2-2757-6117 Website:http://www.india.org.tw E-mail: [email protected]

國貿大樓-台北市基隆路一段 333 號