Indian Restriction Area Permission Form

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RESTRICTED/ PROTECTED AREAS

PERMIT APPLICATION FORM

1. Name (in Capital Letters) ---------------------------------------------------------------------------------------------

2. Father’s name-----------------------------------------------------------------------------------------------------------

3. Place and Date of Birth------------------------------------------------------------------------------------------------

4. Nationality:

a) Present----------------------------------------------------------------------------------------------------------

b) Past, ‘till which date-----------------------------------------------------------------------------------------

c) Reason(s) for change-----------------------------------------------------------------------------------------

5. Occupation--------------------------------------------------------------------------------------------------------------

6. Address------------------------------------------------------------------------------------------------------------------

7. Address in India, if any------------------------------------------------------------------------------------------------

8. Passport details:
a) Number---------------------------------------------------------------------------------------------------------

b) Issued by-------------------------------------------------------------------------------------------------------

c) Issued at--------------------------------------------------------------------------------------------------------

d) Validity--------------------------------------------------------------------------------------------------------

9. Details of Visa for India, if any obtained:

a) Issued by-------------------------------------------------------------------------------------------------------

b) Number--------------------------------------------------------------------------------------------------------

c) Valid up to-----------------------------------------------------------------------------------------------------

10. Places proposed to be visited----------------------------------------------------------------------------------------

-------------------------------------------------------------------------------------------------------------------------------

11. Route intended to be followed--------------------------------------------------------------------------------------

-------------------------------------------------------------------------------------------------------------------------------

12. Purpose of visit--------------------------------------------------------------------------------------------------------

13. Date(s) of visit---------------------------------------------------------------------------------------------------------

14. Have you previously visited any Restricted/Protected areas in India? If so, please give

a) Purpose of visit-----------------------------------------------------------------------------------------------

b) Date(s) of visit------------------------------------------------------------------------------------------------
c) Place(s) visited------------------------------------------------------------------------------------------------

15. Has any earlier request for permit been refused? If so, please furnish details--------------------------------

-------------------------------------------------------------------------------------------------------------------------------

The information given above is correct and complete to the best of my knowledge.

Signature of the applicant------------------------------------------------------------------------------------------------

Place-----------------------------------

Date----------/-------------/------------

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