VISA APPLICATION FORM FOR KINGDOM OF BHUTAN
(Please fill in block capital)
1.
Name in Full: ________________________________________________________
(Surname)
2.
Date of Birth: ____________________________
(Day)
Male
(Month)
Female
(Year)
3.
Sex :
Marital Status:
Married
Single
4.
Nationality : ____________________________________________
5.
Passport No: _______________________ Place of issue: ____________________
Attach passport
size Photograph
(3.5 x 4.5 cm)
Date of Issue: ___________________ Valid until: ________________________
(DD– MM–YYYY)
(DD– MM–YYYY)
6.
Nature of Passport:
Diplomatic
Official
Ordinary
UN Laissez Passer
7.
Permanent Address: ______________________________________________________________________
__________________________________________________Tel No.___________________________
8.
Occupation/Profession: ________________________________________________________________
9.
Period for which visa is required: from___________________ to ______________________
(DD–MM–YYYY)
(DD–MM–YYYY)
10.
Port of entry/exit into Bhutan: Entry Port____________________ Exit Port ______________________
11.
Purpose of visit to Bhutan:________________________________________________________ _____
12.
Is this your first visit to Bhutan?
Yes
No
If No, give details of earlier visit
____________________________________________________________________________________
____________________________________________________________________________________
I hereby declare that the statement given above is true and correct. I fully understand not to indulge in any
activity which, are inconsistent with the purpose for which I have stated above. I understand that the period of
stay to be granted is decided by the Bhutanese Immigration Authorities upon my arrival.
Date : __________________
Place: _________________
Signature of Applicant ________________
For Official use only
Type of Visa
:____________________________
Visa Number
:____________________________
Date of Issue
: ___________________________
Visa Clearance No. : ___________________________