Form 'C'

Arrival Report of Foreigner in Guest House

Applicant ID : 131218C2WL1H

131218C2WL1H

Accomodation Details
Name Arka guest house

Address Arka guest house, Arka, Auroville 605101

City/District PONDICHERRY AND AUREVILLE

State PUDUCHERRY

Star Rating Others

Phone no. 2623799

Mobile no. 8940193850

Personal Details
Surname CROLIUS
Given name WILLIAM CLINTON
Sex Male
Date of birth 03/06/1948 Special Category Others
Nationality UNITED STATES OF AMERICA
Address in country where residing permanently
Address 273A 29TH STREET SAN FRANCISCO,CALIFORNIA 94131 USA
City SAN FRANCISCO
Country UNITED STATES OF AMERICA
Address/Reference in India
Address ARKA GUEST HOUSE,CROWN ROAD,AUROVILLE
City/District VILLUPURAM
State TAMIL NADU
Pincode 605101
Passport Details
Passport No. 533028499
Place of Issue SAN FRANCISCO, UNITED STATES OF AMERICA
Date of Issue 03/05/2015
Expiry Date 02/05/2025

Visa Details
Visa Number VJ5575215 Date of Issue 11/08/2015
Valid Till 10/08/2025 Visa Type TOURIST VISA
Place of Issue san francisco, UNITED STATES OF AMERICA

Arrival Details
Arrived From CHENNAI , KATMANDU , NEPAL
Date of arrival in India 11/12/2018
Date of Arrival in Guest 11/12/2018
House
Time of Arrival in Guest 16:30 Intended Duration of Stay in 19
House Guest House

Whether Employed in India N

Other Details
Purpose of Visit Tourism
Next Place KATMANDU
Destination City KATMANDU
Country NEPAL
Contact No.(in India) 0413 2623799
Mobile No.(in India)
Contact No.(Permanently residing 977 9013519273
country)
Mobile No.(Permanently residing
country)
Remarks(If any)
Remark

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