Web Registration Date : **-DEC-**** Application Id : YEMS01839222

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YEMS01839222

EMBASSY OF INDIA SANA YEMEN

: 24th Street off Hadda Road in front of

Hadda Post office Sanaa, Yemen

www.eoisanaa.org

+967-*-******

Visa Application Form

Signature

A. Personal Particulars (As in Passport)

Surname (As in Passport) AMRAN

Given Name (As in Passport) AMEEN ADEL SALEH MOHAMMED Previous/other Name if any Not Applicable

Gender MALE Marital Status SINGLE

Date of Birth 18-JAN-1993 Religion ISLAM

Place of Birth Town/City IBB Country of Birth YEMEN Citizenship /National ID No NA Educational Qualification OTHERS Visible identification marks NA

Current Nationality

YEMEN

Nationality by Birth/

Naturalization BY BIRTH

Any Other Previous/Past Nationality Not Applicable B. Passport Details

Passport No. 11932963 Date of Issue ( dd/mm/yyyy ) 25-SEP-2022 Place of Issue TAIZ Date of Expiry ( dd/mm/yyyy ) 25-SEP-2028 Any other Passport/Identity Certificate held (if yes,please fill in the following) NO Country of Issue Place of Issue

Passport/IC No. Date of issue (dd/mm/yyyy)

Nationality/Status

C. Applicant's Contact Details

Present SANAA Phone No 770695496

Address SANAA Mobile /Cell No

SANAA, YEMEN 00967 Email address ad1m02@r.postjobfree.com Permanent SANAA

Address SANAA

SANAA

D. Family Details

Relation Name Nationality Prev. Nationality Place/Country of Birth Father's ADEL SALEH MOHAMMED AMRAN YEMEN YEMEN

IBB

YEMEN

Mother's

ASMA ALI ABDULLAH ADEL

MOHAMMED ALSAADI YEMEN YEMEN

IBB

YEMEN

Marital Status Single

Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO AMEEN ADEL SALEH MOHAMMED AMRAN

E. Details of Visa Sought (Visa shall be valid from the Date of Issue and not from the Date of Journey) Type Of Visa Required STUDENT VISA No of Entries DOUBLE Period of Visa ( Month) 12 Month Expected Date of Journey 08-JAN-2023 Port Of Arrival MUMBAI Port of Exit

Required Detail of STUDENT VISA

Application Id : YEMS01839222

Institution LOVELY PROFESSIONAL UNIVERSITY

Address PUNJAB

Phone 009***********

Email

Course Detail INFORMATION TECHNOLOGY

Duration 4 YEARS

Purpose of Visit : FOR HIGHER EDUCATION (INCLUDING IN SOUTH ASIAN UNIVERSITY AND NALANDA UNIVERSITY), PROVISIONAL STUDENT VISA, FOR SHORT TERM COURSES AND FOR THOSE COMING UNDER STUDENT EXCHANGE PROGRAMME

F. Previous Visit Details

Have You Ever visited India ? NO

Address where You stayed in

India,

Cities in India Visited

Type of Visa Visa Number

Visa Issued Place Date of Issue

Countries visited in last 10 years NA

Have you been refused an Indian Visa or extension of the same previously or deported from India ? NO G. Profession/Occupation Details :

Present Occupation LABORER Designation/Rank

Employer name/business SAEED ABDO MOHAMMED

Employer Address

Phone Number SANAA

Past occupation if any

Are/have you worked with Armed forces/ Police/ Para Military forces ? NO Organization Designation

Place of Posting Rank

H. Details of Two Reference

In India In YEMEN

Name

LOVELY PROFESSIONAL

UNIVERSITY AMEEN ADEL SALEH MOHAMMED AMRAN

Address PUNJAB SANAA

NOT KNOWN PUNJAB

Phone Number 009*********** 770695496

J. DECLARATION

a. I do not hold any other passport(s) other than those detailed above. b. I have read and understood all the conditions for the visit to India and I am willing and able to abide fully by them. c. I declare that the information given in the form is complete and correct and the visit to India will be undertaken for the purpose indicated in the application.

d. I understand that in case the information provided in the form is found to be incorrect, I will be liable for denial of visit/ entry or deportation and/ or other penalties during the visit as provided by Indian law. e. I will also submit hard-copy all the uploaded documents along with the print of application to submit to the concerning Indian Mission or Agency for processing of visa application. 08-DEC-2022

Date : Applicant's signature (as in Passport)

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