PROFORMA (MoP&NG/ONGC/DGH) (Foreign nationals including Crew) 1. Name of the Foreigner (in capital letters With surname underlined) 2. Father's Name 3. Place/Country and Date of birth 4. Nationality 1) Present 2) Past 5. Occupation (Address of employer, if employed) 6. Present Address BAIOFe 7. PermanentAddress 8. Reference a) In country of applicant b) In India J GORD, 9. Passport details a) Number Sb) Issued at (place/country) ©) Date of Issue ) Valid up to 10.Details of Visa for India, if obtained No. Issued by At Valid Until 11, Places of Visit 12. Purpose of Visit 13. Port of Entry into Inia 14, Likely date of visit 15. Duration of visit 16.Details of previous visits to India, if any 17. Has he/she /they previously visited any restricted area or protected area in India? If so details thereof 18, Has any earlier request for the permit/VISA been refused? If so, details thereof : HARRY WALTON BELL + HARRY LANCASTER BELL : LOUISIANA, U.S.A, 05.06.1959 : UNITED STATES OF AMERICA : UNITED STATES OF AMERICA MASTER, 1 M/S. SWIBER OFFSHORE CONSTRUCTION PTE. LTD. '502-B WING, DELPHI, HIRANANDANI GARDENS, POWA\, MUMBAI76. £726, EAST 590, NORTH SMITHFIELD, UTAH, U.S.A. 84335 + MR. ENGELBERT DSILVA # MR, DHIRAJ GONDANE 1 488029928 UNITED STATES OF AMERICA 30.10.2012 : 29.10.2022 INDER PROCESS : ONGC MUMBAI HIGH OFFSHORE FIELD : TO JOIN SWIBER VESSELS/BARGES MUMBAI : DECEMBER 2014 1 YEAR :No No No The information given above is correct to and complete to the best of my knowledge Dated: Place: Nalts fu ignatire of applicant