INDIA - eMEDICAL VISA QUESTIONNAIRE...INDIA - eMEDICAL VISA QUESTIONNAIRE Supporting documents...
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INDIA - eMEDICAL VISA QUESTIONNAIRE Supporting documents needing to be emailed to your Account Manager. - Passport copy - Passport style photo - Copy of letter from Indian hospital detailing medical procedure - If applicant holds dual nationality, a copy of the other passport will be required. Questionnaire: TRAVELER INFORMATION 1 - Applicant’s Full Name 2 - Have you ever changed your name? If yes, previous name 3 - City/Country of Birth 4 - Religion 5 - Education Level 6 - Have you lived at least 2 years in the US? 7 - Present address (if different than that in your Passportsandvisas.com order) If Yes, Organization, Designation , Rank, Place of Posting 9 - Employer/School Name Address / Phone Yes No Yes No Triple Entry, 60 day validity per entry 10 - Are/were you in the Military/Semi-military Police/Security organization? Yes No
Transcript of INDIA - eMEDICAL VISA QUESTIONNAIRE...INDIA - eMEDICAL VISA QUESTIONNAIRE Supporting documents...
INDIA - eMEDICAL VISA QUESTIONNAIRESupporting documents needing to be emailed to your Account Manager. - Passport copy - Passport style photo - Copy of letter from Indian hospital detailing medical procedure - If applicant holds dual nationality, a copy of the other passport will be required.
Questionnaire:TRAVELER INFORMATION
1 - Applicant’s Full Name
2 - Have you ever changed your name?
If yes, previous name
3 - City/Country of Birth
4 - Religion
5 - Education Level
6 - Have you lived at least 2 years in the US?
7 - Present address (if different than that in your Passportsandvisas.com order)
If Yes, Organization, Designation , Rank, Place of Posting
9 - Employer/School Name
Address / Phone
Yes No
Yes No
Triple Entry, 60 day validity per entry
10 - Are/were you in the Military/Semi-military Police/Security organization?
Yes No
11 - Father’s Details
12 - Mother’s Details
Name
14 - Were your Parents/Grandparents Pakistan Nationals or Belong to Pakistan held areas?
If yes, give details below:
Current Nationality
Previous Nationality (if any)
Place of Birth (city,state, country)
13 - Marital Status: Married DivorcedSingle
Name
If married, Spouse Details:
Current Nationality
Previous Nationality (if any)
Place of Birth (city,state, country)
Name
Current Nationality
Previous Nationality (if any)
Place of Birth (city,state, country)
Yes No
Trip Information Details
15 - Port of Arrival (Name of Airport or Seaport)
16 - Port of Exit (Name of Airport or Seaport)
17 - Expected Date of Arrival in India
18 - Expected Date of Departure
19 - Cities to be visited
Hospital Details
20 - Name of Hospital
Address of Hospital(state/district)
Phone of Hospital
Type of Medical Treatment
Options: Ahmedabad, Amritsar, Bagdogra, Bangaluru, Calicut, Chandigarh, Chennai, Cochin, Cochin Seaport,Coimbatore, Delhi, Gaya, Goa, Goa Seaport, Guwahati, Hyderabad, Jaipur, Kolkata, Lucknow, Mangalore, Mangalore Seaport, Mumbai, Nagpur, Pune, Tiruchirapalli, Trivandrum, Varanasi
Options: Ahmedabad, Amritsar, Bagdogra, Bangaluru, Calicut, Chandigarh, Chennai, Cochin, Cochin Seaport,Coimbatore, Delhi, Gaya, Goa, Goa Seaport, Guwahati, Hyderabad, Jaipur, Kolkata, Lucknow, Mangalore, Mangalore Seaport, Mumbai, Nagpur, Pune, Tiruchirapalli, Trivandrum, Varanasi
Travel History
Yes No
21 - Have you been to India before?
22 - Have you visited SAARC countries (except your own country) during last 3 years? (Afghanistan, Bhutan, Pakistan, Maldives, Bangladesh, Sri Lanka, Nepal)
23 - Countries visited in last 10 years? Please list most recent 5 countries.
If Yes, provide details:
Address of stay during last visit
Cities previously visited
If Yes, provide details:
Previous India visa Details:
Visa number
Type of Visa
Place of Issue
Date of Issue
24 - Reference Person in India
Name
Address
Phone
25 - Emergency Contact in USA
Name
Address
Phone
