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Signature
I004V276E115
Application Id :I004V276E115
Date of birth
Place of Birth Town/City
Citizenship /National ID No
Visible identification marks
Current Nationality
Female
16-JUN-1962
PAMPA DEL INDIO
16217663
NONE
ARGENTINA
Marital Status
Religion
Country of Birth
Educational Qualification
Married
CHRISTIAN
ARGENTINA
HIGHER SECONDARY
BY BIRTH
01-AUG-2014
01-AUG-2024
AAC100083
ARGENTINA
Passport No.
Place of issue
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. Applicants Contact Details
Present
address
Phone No
540372515433275
Email address nateelpi@gmail.com
Mobile /Cell No
Name
Nationality
Prev. Nationality
Place/Country of Birth
Fathers
GONZALEZ JIMEME
ARGENTINA
Mothers
SEGUNDO SERVILIANA
ARGENTINA
Spouse
GARCIA MIGUEL
ARGENTINA
(Visa shall be valid from the Date of Issue and not from the Date of Journey)
TOURIST VISA
34 Days
DELHI AIRPORT
AURELIANA GONZALEZ
No of Entries
Expected Date of Journey
Port of Exit
Single
02-NOV-2015
DELHI AIRPORT
Required Detail of
TOURIST VISA
SHILLONG
NO
Application Id :I004V276E115
Places to be Visited
Phone
+91 9774892439
Number
State
Phone No.
In
LILYAN NORIEGA
SAAVEDRA 280
+54 3704420945
J. DECLARATION:
a.
b.
c.
d.
I do not hold any other passport(s) other than those detailed above.
I have read and understood all the conditions for the visit to India and I am willing and able to abide fully by them.
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.
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.
19-OCT-2015
Date :.
..
Applicants signature (as in Passport)