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REGISTRATION CERTIFICATE

1. R.O NO.

2. Date & Place of Birth

3. NAME IN FULL (block letters, surname first)

4. Sex, Height, Color of Birth

5. Present Nationality

6. Previous Nationality

7. Manner and Date of acquiring present Nationality

8. Occupation / Profession  and purpose of visit to India

9. If a member of any country’s naval, military, airforce or its reserves, state which country’s  and rank India

10. No. Date and place of passport issued or particulars of their proof of identity and its validity

11. Address or intended address in India

12. Port or place of embarkation of departure to India

13. Date and placed of arrival in India

14. Name of vessel on which or how you arrived in India

15. Address of last residence outside India

16. Name of husband / wife / children and their nationality (if accompanying the visitor)

Signature Photo                                                                                                                                     Registration Officer

                                                                                                                                                         Date:

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