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Embassy of Nepal

Dhaka, Bangladesh

VISA APPLICATION FORM

Embassy of Nepal

Baridhara, Dhaka, Bangladesh.

I request you to issue diplomatic /official /tourist visa for me as I am interested to visit Nepal. My details are as under :

1. Name (in Block) : Mr./Mrs./Miss :

(First) (Middle) (Surname)

2. Father’s / Husband’s Name : 3. Nationality : 4. Place of Birth : 5. Date of Birth : 6. Occupation : 7. Permanent Address :

Tel No. : 8. Present Address :

Tel No. : 9. Passport No. : 10. Date of Issue : 11. Date of Expiry : 12. Address in Nepal : Tel No. : 13. Purpose of Visit to Nepal : (a) Tourism (b) Official (c) Others : 14. Probable date of arrival in Nepal : 15. Duration of stay in Nepal : (a) day. (b) Week. (c) Month 16. Expenses in Nepal to be borne by : (a) Self (b) Sponsor by (c) Other : 17. Date & duration of stay during the previous visit to Nepal (if any) : 18. Name and the date of birth of member(s) of the family if endorsed in the same Passport : Name Date of Birth

a. b. Date :

Signature of the Applicant

N.B. : Please visit Embassy website "www.nepembassy-dhaka.org" for details. Photo

FOR OFFICIAL USE ONLY

1. Visa type : 2. Visa sticker number : 3. Validity of Visa : 4. Date of Issue : 5. Visa fee : Tk.

Date : Signature of the Officer