†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††

 

††††††††† ††††††††††††††††††††††††††††††††††††††††††††††††††††APPENDIX XXII

†††††††††††††††††† †††††††††††††††††††††††††††††††††††††††††††††††Para 139(1)

 

††††††††††††††††† ††††††††††††††††††††††GOVERNMENT OF INDIA

††††††††††††††††† ††††††††††††††††††MINISTRY OF HOME AFFAIRS

 

 

††† †††††††††††††††††REQUEST FOR SPECIAL PERMIT FOR PROTECTED AREAS

†††††††††††††††††† †††††††††††††††††††††(Application to be submitted in duplicate)

 

 

 

 

 

††† Photograph

 

 

 

†††† 1. Name of the Applicant: ________________________________________________

††††††† (in capital letters with Surname underlined)

 

†††† 2. Fatherís Name: ______________________________________________________

 

3. Honorifics: Mr./Miss/Mrs. ______________________________________________

††† ††(Score out those not applicable)

 

††† 4. Surname at birth, if different: ____________________________________________

 

††† 5. Place and date of Birth: ________________________________________________

††† ††††(Your Town and Country)

 

††† 6. Nationality: (a) Present ________________________________________________

†††††††††††††††††††††† ††††(b) Past, if different, till which date ______________________________

††††††††††††††††††††† †††††(c) Reason for change________________________________________

 

††† 7. Occupation: _________________________________________________________

††††††† (Give address of place of work if employed)

 

††† 8. Permanent Address: _______________________________≠≠≠≠≠≠≠___________________

 

††† 9. Mailing address in India, if any: __________________________________________

 

10. Reference (a) In country of applicant _____________________________________

†††††††††††††† †††††††††††(b) In India _________________________________________________

 

 

11. Passport Details: No: __________________________________________________

†††††††† †††††††††††††††Issued by: __________________________________________________

†††††††††††††††††††††††††††††††††† ††††At______________________ valid up to ___________________

 

12. Details of visa for India if any obtained:

††††††††††††††††††††††††††† ††††††††††††††††††††††††††Issued by:____________________________________

††††††††††††††††††††††††††††††††††††††††††††††††† ††††††Number_____________________________________

††††††††††††††††††††††††††††††††††††††††††††††††††††††††† †††††††At ____________________________________

††††† ††††††††††††††††††††††††††††††††††††††††††††††Valid up to ____________________________________

 

13. Places proposed to be visited: ___________________________________________

 

14. Route intended to be followed: ___________________________________________

 

15. Purpose of visit: ______________________________________________________

 

16. Likely date of visit: ____________________________________________________

 

17. Likely duration of visit: _________________________________________________

 

18. Is anyone accompanying the applicant?

††††† If so, give details: _____________________________________________________

 

19. Arrangements for travel and accommodation that may have been made.

†††††† ___________________________________________________________________

 

20. Details of previous visits to India: _________________________________________

 

21. Has/have He/She/They previously visited any Restricted / protected area in India

†††††† or Bhutan?

†† ††††If so, please give details of the places visited and date of visit.

 

††††††† ___________________________________________________________________

 

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

††††††† ___________________________________________________________________

 

 

†††††††††††††††††††††††††††††††††††††††††††††††††††††† -:DECLARATION:-

 

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

 

††††† Place_______________________

 

†††††† Date________________________†††††††††† ††††††††††††††Signature of Applicant

 

 

NOTE :- 1. This application is to be sent to the Ministry of Home Affairs, New Delhi.

††††††††††††††† 2. It is advisable to make the application at least eight weeks ahead of the

†††††††††††† ††††††date of the proposed visit.

††††††††††††††† 3. Applicants outside India are expected to route their application

††††††††† ††††††††††††through the nearest Indian Diplomatic or Consular Mission.