HIGH COMMISSION OF INDIA

HIGH COMMISSION OF INDIA

KUALA LUMPUR
APPLICATION FORM FOR VISA

No. 2. Jalan Tarnan Duta, Off Jalan Duta,

5O480 Kuala Lumpur. Tel: 03-20933504,
509, 510 & 511 Fax: 603-20922752
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10
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NOTE: Application is to be filled and signed by the applicant only and not by
any agent. Application with incomplete details are liable to be
rejected.

Requirements:Application form to be completed in all respect:-Three recent passport size photographs (5cm x
3cm) Passport / Travel Document to be valid for at least six months
Transit Visa
: To produce confirmed air ticket
Tourist
Visa
: Nil
Business
Visa
: To adduce proof of business in India
Student
Visa
: To adduce proof of admission in a recognised institution in India
Employee
Visa
: To adduce proof of employment in India
Other
Visa Consult the Counter
VISA FEE as on : To be paid in cash (postal order/bank draft in case of outstation
01.10.2000
in favour ol High Commission of India, Kuala Lumpur).
(a)
(b)
(c)
(d)
(e)
(f)
(g)

Transfer of Visa
Transit Visa
Visa valid up to 6 months (Tourist/Business)
Visa valid for 1 year (Business/Employment)
Student Visa (for duration of the Course or for the
5 years which ever is less)
Visa valid for more than 1 year up to 5 years (Except
Visa)
Processing Fee
(For non-Malaysian Passports)

Photo

For Office Use

RM
RM
RM
RM

19.00
38.00
152.00
247.00

RM

285.00

RM

494.00

Visa..

RM

40.00

Visa

Receipt
No

period of

Type

Student

of

No.&

Date.
Note: 1. Postage RM2.00 (Subject to revision) or stamped self addressed envelope, for return by
Registered Post.
2. Visa application would be received between 0930 hrs. to 1200 hrs. during any working
day.
3. Collections of Visa - 1630 hrs. to 1700 hrs. on the due date.

PART A
4. For Non Residents in Malaysia, a processing time of minimum 3 working days required.

(a) Full Name (in Block Letters)

Mr./Mrs./Miss
(b) Surname at birth (if different)......................
...
(c)

Marital Status..............................................

...
(d) Father's Name.............................................
..
(e) Husband's Name (if applicable)..................
..
2. Whether any children accompanying the applicant are included in his / her passport. If
so, give the following details:Name

Place & Date of Birth

Sex

Relationship

Identification
mark if any

i)
____________________________________________________________________________________________________________________________

_
ii )
____________________________________________________________________________________________________________________________
iii )
____________________________________________________________________________________________________________________________
iv )
____________________________________________________________________________________________________________________________

3. Address

(a)

Permanent ......................................................

(b)

Present...........................................................

..
Telephone No. in Malaysia ............................................
4. Date of Birth ............................................................. 5. Place of Birth .
..

(Place)

(Province)

(Country)

6. Present Nationality .........................................................................................................

7. Any other Nationality previous or present with details ...................................................

8. Profession or Occupation (give details of company and its address with Tel & Fax No.)

9. Passport particulars
(a) Number............................................................................................. (b) Place of Issue ..
(c) Date of Issue ...................................................................................... (d) Date of expiry
(e) Identity Card No. (for Malaysian Only)................................................................................... (!)
Date of Expiry of Re-entry permit..........................................................................................

10.

Have you visited India previously

Is so indicate places ............................................................................................ dates .......................
(from present to past)........................................................................................... dates .......................
............................................................................................dates .......................

11. Whether permission to visit India or to extend stay in India has been refused previously? If so when
..
12. (a) Period for which visa is required ...................................................................................................
(b) Probable date of arrival in India ....................................................................................................
(c) Whether a single, double, triple or multiple visa is required ..........................................................
13.

Purpose of Journey
(a) Transit (Place/Country to be visited further) ..................................................................................

(b) Tourism (Place/area to be visited).................................................................................................

(c) Business (Trade/Project Scheme Enclose Letter From Indian Company & Malaysian Company)

.
(Party/Parties/person to be contacted with address)

.
(d) Education ................................................................................
Name and particulars of educational institution to be attended
(e) Employment (Furnish details)...............................................

(f) Any other .................................................................................

PART B

1.
2.
3.

Whether holding valid, 'No objection to Return Endorsement', if so, give particulars

State, Town, etc. of destination in India ........................... ...................... .......................... .................. .....
(a) Port of landing in India ..............................................................................................................

(b) Port of departure from India .............................................................................................................

4.

Name and address of person who will furnish information as to applicant and also furnish guarantee for
maintenance and repatriation if referred to:
IN COUNTRY OFTHE APPLICANT

( i )
( ii )
IN INDIA
( i ).

( ii )..
PART C
I, ............................................................................. hereby undertake that I shall utilise my visit to India for the
purpose for which the visa has been granted and shall not, on arrival in India, try to obtain employment or set up
business or to extend my stay for any purpose. I fully understand that if any of the particulars furnished above are
found to be incorrect, or if any of the information is found to have been withheld, the visa is liable to be cancelled at
any time. (Declaration to be made by applicants seeking to stay in India for more than one year), I hereby
undertake that I shall subject myself to medical tests including for AIDS within one month of arrival in India. In case
I am found HIV positive, I will leave India.

Date:...................................................

..........................................................
Signature of the applicant