PART-I

Embassy of Pakistan 3517 International Court N.W

Washington, D. C. 20008 info@embassyofpakistanusa.org

(Visa Application Form)

1. TYPE OF VISA APPLIED FOR:

Diplomatic Official Military Business Tourist

Family Transit Journalist Others (specify)__________________________________

2. Purpose of visit: ____________________________________________________________________________

3. Duration of Stay :____________________________________________________________________________

4. Visa required for: 01 month 06 months 1 year 02 years 05 years

5. Number of Entries : Single Double Multiple

6. i) Port of Entry in Pakistan________________________________________________________________

ii. Port of Departure from Pakistan _________________________________________________________

iii. Place (s) to be visited in Pakistan :

a. ________________________________________b. ______________________________________________

c. _________________________________________d.______________________________________________7. SECTION -I (APPLICANT’S PARTICULARS)

i. Name as in Passport: ________________________ __________________ __________________________ First Middle Last

ii. Date of Birth: __________________________________ dd/mm/yyyy

iii. Place of Birth: City_______________________________ Country______________________________

iv. Sex: Male Female v. Blood Group______________

vi. Marital status: Single Married

vii. Identification mark: ___________________________ viii. Native language____________________________

ix. Nationality: (a) Present_____________________________(b) Previous ________________________________

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Your photographs must be:

Passport size (45mm high x 35mm wide)

A recent and likeness, showing full face with no

hat, helmet or sunglasses although you

can wear every day glasses

x. Religion:_________________________________

8. PASSPORT DETAILS:

Type of Passport/ Diplomatic Official/Service Ordinary UN Travel Document

Passport Number: ________________________________ Place of issue __________________________ Date of issue: ________________________________ Date of Expiry___________________________ Issuing authority ________________________________________________________________________

9. ADDRESS & CONTACT DETAILS:

a. Address in USA/Country of Origin __________________________________________________________

Telephone: i) Home____________________ ii) Work ____________________ iii) Cell ____________________

b. Address in Pakistan _______________________________________________

Telephone: i) Home__________________ ii) Work____________________ iii) Cell _______________________

E-mail: _________________________________________________________________

10. Is your visit sponsored? Yes No If yes, give details. Name of Sponsor Address Contact Number _____________________ ____________________________ ______________________________ _____________________ ____________________________ ______________________________ _____________________ ____________________________ ______________________________

11. DETAILS OF PROFESSION :

a. Profession :_____________________________________________________________________________________

b. Employer’s/sponsor’s details (in Pakistan/abroad (if applicable)

Name Address Home Office Cellular Email address

b) In case of military services, (armed forces and allied services), Please fill in the proforma: Annexure “A”

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n/a

12. DETAILS OF JOBS HELD IN THE PAST:

a. Designation___________________________ b. Department __________________________ c. Duration (from-to)______________________ d. Duties ______________________________ e. Job address & Phone No.______________________________________________________________

f. Name, address and contact numbers of the supervisor or a colleague, (use extra sheet if required): _____________________________________________________________________________________

_____________________________________________________________________________________

13. Are you applying visa from a third country? Yes No If yes, please provide copy of Residence/Work Permit of that country ____________________________________________________________________________________________

14. SECTION-II (FAMILY DETAILS)

i. Name of mother __________________________ii. Nationality of mother_________________________

ii. Name of father__________________________ iv. Nationality of father__________________________

v. Spouse details:________________________________________________________________________

Name____________________________________ Nationality __________________________________ Date and place of birth__________________________________________________________________ Profession:_________________________ Name, address and contact number of the employer of spouse (if any) _________________________

_____________________________________________________________________________________

15. Do you have any children? Yes No If yes, please provide details for each of your child.

Name ________________________________________________________________

________________________________________________________________

Date of birth ________________________

________________________

16. Please list any accompanying person / family member (including children) travelling with you to Pakistan.

Full Name 1.__________________________2.__________________________3.__________________________

Date of Birth __________________________________________

Passport No. (if any) _______________________________________________________________

Address _______________________________________________________________

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17. Do you have any bank account in Pakistan : Yes No

Bank Name _________________________________

Branch_______________________________________

A/C Number __________________________________________

Address _______________________________________________________________

Verifier details _________________________________________________________

18. TRAVEL HISTORY:

i. Have you ever visited Pakistan during last five years? Yes No if yes, please provide details:

Date Destination/Address Purpose Duration 1._________________________________________________________________________________________

2._________________________________________________________________________________________

3._________________________________________________________________________________________

4._________________________________________________________________________________________

5._________________________________________________________________________________________

ii. Details of other countries visited, during last two years:

Date Destination/Address Purpose Duration 1.__________________________________________________________________________________________2.__________________________________________________________________________________________3.__________________________________________________________________________________________4.__________________________________________________________________________________________

iii. Have you ever been refused a visa for any country, including Pakistan?Yes No

iv. Have you ever been refused entry on arrival in Pakistan? Yes No If yes, please provide details of refusal.

1.__________________________________________________________________________________________2.__________________________________________________________________________________________3.__________________________________________________________________________________________4.__________________________________________________________________________________________

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19. Have you ever been deported, removed or ordered to leave any country, including Pakistan? Yes No If yes, please provide details of refusal.

1._________________________________________________________________________________________2.________________________________________________________________________________________3._________________________________________________________________________________________4._________________________________________________________________________________________

20. Do you have any criminal convictions or been charged in any country?Yes No If yes, please provides details.

Date Country Offence Sentence

21. DECLARATION:

I declare that the information given in this form is correct to the best of my knowledge and belief and if any of the particulars furnished above are found to be incorrect or withheld the visa is liable to be rejected/cancelled at any time

Date___________________ __________________ (Signature of Applicant)

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PROCESSING CERTIFICATE (FOR OFFICIAL USE – NOT TO BE FILLED BY APPLICANT)

1. Date of receipt of visa application _____________________________________________________________2. Registration No. ___________________________________________________________________________3. Visa fee received___________________________________________________________________________4. Additional documents received________________________________________________________________

a. _______________________________ b. ____________________________________ c. _____________________________ d. ____________________________________

5. Particulars of official who checked the visa form for its corrections and supporting documents:

Name: _______________________________ Designation: ______________________________________

Date: _______________________________ Signature: __________________________

6. Details of clearance received from Ministry of Interior.

No. __________________________ Date: _______________

7. Decision of office Incharge:

a. Accepted b. Regretted c. Type of visa issued: _____________________________________________________ d. Duration: ______________________________________________________________ e. Single Entry f. Multiple Entry g. No. of entries: __________________________________________________________

Date: _________________________ ___________________________ (Signature of Visa Issuing Authority)

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