LIAISON OFFICE OF THE EMBASSY OF INDIA IN BHUTAN, PHUENTSHOLING







(Please affix recent passport size photograph)

APPLICATION FORM FOR ISSUE OF IDENTIFICATION SLIP/NON-TRANSFERABLE

Sl. No.

Full Name
 (in block letters)

 Male/Female Age Place of birth Father's/Husband's Name Profession
1.            
2.            
3.            
4.            
5.            
6.            
  ......(Person(s) only)          
1. Address in India: ______________________________________________
2. Purpose of visit: Tourism/Business/Due Collection/Meeting Relatives. _______________________________________________
_______________________________________________
3.

Places to be visited : Thimphu / Paro / Chukha / Chimakothi / Tsimalakha / Pasakha

 ____________________________________
______________________________________
4. Duration of stay in Bhutan: 3(Three) / 5(Five) / 7(Seven)days. ____________________________________
____________________________________
5. Name(s), relationship and Address of person(s) in Bhutan whom I am visiting: ____________________________________
__________________________________
6. Photocopy of document(s) with
photo affixed and attested,
attached as proof of being an
Indian national:		 Passport/
Election Commission Card/PAN Card
Gram Panchayat Residence Certificate
Court Affidavit / Driving License / Credit Card

I solemnly declare that the above person(s) is/are Indian national(s) and this declaration is true.

Date:__________________

Signature :___________________
(For Official Use)

Identification Slip No.

Date: ____________________

 

(L.W.Bhutia)
Liaison Officer