Reference No: DELA0025926

Please Indicate Type of Visa Requested

Diplomatic Visa
Please attach Official Visa
2 photographs Courtesy Visa
taken within Non-Immigrant Visa
the last 6 months APPLICATION FOR VISA Tourist Visa
(3.5 x 4.5 cm) Transit Visa
The Ministry
Royal of Foreign
RoyalThai
Thai Affairs
Embassy,
Embassy, of Thailand
New
New Delhi
Delhi SINGLE
Number of Entries Requested _____

Mr. Mrs. Miss ANUPAM BISWAS

First Name Middle Name Family Name (in BLOCK letters)

Former Name (if any) Countries for which travel document is valid
ALL COUNTRIES
Nationality INDIA
Proposed Address in Thailand SLEEP WITH ME DESIGN HOTEL,
Nationality at Birth INDIA
187/5 RAT-U-THIT 200 P BAIYOKE SKY HOTEL, 222, THANON

Birth Place BANGALORE

Marital Status SINGLE PLAYA THAI, RATCHAT PHUKET 83150

Date of Birth 21/11/1987 Name and Address of Local Guarantor

DEEPAK KUMAR 186/2, FLAT NO-14 JAWAHAR ESTATE, IGNOU ROAD,

Type of Travel Document PASSPORT NEB SARAI ROAD DELHI 110068

No. H8900990 Issued at BANGALORE Tel./Fax. 919718767337

Date of Issue 07/12/2009 Expiry Date 06/12/2019 Name and Address of Guarantor in Thailand
SLEEP WITH ME DESIGN HOTEL 187/5 RAT-U-THIT 200 PEE ROAD,
Occupation (specify present position and name of employer) PATONG BEACH, KATH BAIYOKE SKY HOTEL, 222, THANON PLAYA THAI, RATCHAT P
PRODUCT MANAGER
Tel./Fax. 6676363333
MMI ONLINE LTD
I hereby declare that I will not request any refund from
Current Address D-20, 1ST FLOOR PARYAVARAN COMPLEX, IGNOU my paid visa fee even if my application has been declined.
ROAD DELHI 110030 Signature Date 06/02/2017
Attention for Tourist and Transit Visas Applicants
Tel. 9650515516 E-mail ANSI2U@GMAIL.COM
I hereby declare that the purpose of my visit to Thailand
is for pleasure or transit only and that in no case shall I engage
Permanent Address (if different from above)
myself in any profession or occupation while in the country.
Signature Date 06/02/2017

Tel. FOR OFFICIAL USE mfavisaform10092007

Names, dates and places of birth of minor children (if accompanying) Application/Reference No.
Visa No.
Type of Visa:
Diplomatic Visa Official Visa Courtesy Visa
Date of Arrival in Thailand 10/03/2017 Non-Immigrant Visa Tourist Visa Transit Visa
Traveling by INDIGO Category of Visa:
Flight No. or Vessels name 6E 75 Number of Entries:
Single Double Multiple Entries
Duration of Proposed Stay 12 DAYS
Date of Issue Fee
Date of Previous Visit to Thailand
Expiry Date
Purpose of Visit: Tourism Transit Documents Submitted
Business Diplomatic/Official
Other (please specify)
Authorized Signature and Seal