APPLICATION FORM
( Registration Extension , Change of Address and Visa
Extension )
230126632SJQ
Application ID No. 230126632SJQ Final Submission Date Fri Jan 23 14:33:06 IST 2026
FOR OFFICE USE ONLY
Reg. No. S 1 4 1 L B R 2 0 2 6
Personal Details
SII Student ID
Surname MASSAQUOI Paste your
Given Name ROLAND COURAGE Recent passport size
Sex Male Date of Birth 03/12/2001 Height (in cm) 175 photograph here
Age as on today Year(s) 24 Month(s) 1 Day(s) 20
Place of Birth MONROVIA,MONROVIA,LIBERIA
Father's Name MOLLEY G MASSAQUOI
Mother's Name AGNES M T MASSAQUOI
Spouse's Name
Religion CHRISTIAN Any Identification mark(s) preferably NONE
visible
Present nationality LIBERIA Previous nationality
Manner of acquiring present nationality Birth
Date of acquiring present nationality
Whether holding dual NO
nationality? If yes, Name of the country of second nationality
provide the following:- Passport No. of second country
Date of Issue
Date of Expiry
Whether travelled on this passport earlier to
India
Whether person of Indian Origin NO
Address of last residence (Outside India)
Address BERWERVILLE CITY VOA ROAD PARRY TOWN
City MONROVIA Country LIBERIA
Address intended for longer stay in India (Registration)
Address HOUSE NO. 156, NEW SUNDER NAGAR, THREEKE
City/ District LUDHIANA State PUNJAB
Pin Code 142021
Phone Number Mobile Number 9876921147
Any Other Address in India
Address
City/ District State
Pin Code
Phone Number Mobile Number
Email/Occupation/Profession Details
E-Mail Id massaquoirolandc@[Link]
Profession/Occupation STUDENT
Passport Details
Passport Number PP0264212 Place of Issue LIBERIA, MONROVIA
Date of Issue 14/09/2023 Expiry Date 14/09/2028
Visa Details
Visa Number VN1650172 Place of Issue LIBERIA, MONROVIA
Date of Issue 28/01/2025 Expiry Date 27/01/2026
Valid For Triple Entry Visa Type STUDENT VISA
Special endorsement, if any
Organization/Company/Institute/Hospital Details
Name PUNJAB COLLEGE OF TECHNICAL EDUCATION
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230126632SJQ
Application ID No. 230126632SJQ
Address JHANDE, FEROZEPUR ROAD
State PUNJAB City LUDHIANA
Telephone Number 0161-2888500 Email ID studentwelfare@[Link]
Employer EPFO ID Establishment ID
Arrival Details
Place of embarkation/boarding for India ROBERTS INTERNATIONAL AIRPORT,MARGIBI COUNTY,LIBERIA
Date of arrival in India 17/03/2025
Place of disembarkation/arrival in India DELHI
Mode of Journey Air Flight/ Ship/ Bus/ Train No.
Purpose of visit to India Studies
Previous Registration Details in India
Registration Number Place of Registration Visa Type Duration From To
PB12RCFLBR1732025 PUNJAB,LUDHIANA STUDENT VISA 25/09/2025 27/01/2026
Details of family members/attendant/dependents, if any accompanying.
Name Nationality Passport Number Relationship
Person to be contacted in Case of Emergency
Name Relationship
Address City
Country Phone Number
Category Others
Military service details
Organisation Designation
Rank Place of Last Posting
Country of Last Posting
Current Registration Details
Are you registered in current locality FRRO/FRO in the current visit? YES Current PB12/RCF/LBR/173/2025
Registration No.
Reason for Change of Address its expensive
Current Extension Details
Have you got extended visa in current visit in current locality NO Current
FRRO/FRO? Extension No.
Visa Extension Details
Whether previously in India? NO
Whether permission to stay in India has been previously refused? NO
Whether permission to extend stay in India has been previously granted? NO
Period of Extension requried Year(s) 1 Month(s) 0 Day(s) 0
Reason for extension PURSUING STUDY IN BCA COURSE
In case of Missionary - Nature of work
Registration Extension Details
Current Registration Valid Upto 27/01/2026 Required for period of Year(s) 1 Month(s) 0 Day(s) 0
Reason Of Extension PURSUING STUDY IN BCA COURSE
Signature of the Applicant
Date_ _ _ _ _ _ _ _ _ _ _ _ _
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230126632SJQ
Application ID No. 230126632SJQ
List of mandatory and non mandatory documents
Mandatory Documents.
1. Photo : Applicant's Photo
2. Visa : Indian Visa
3. Residence proof : Residence Certificate from Hostel/Updated Form 'C' generated by Hotel/Lodge or Registered/Notarized Lease Deed, Utility Bill, Copy of photo-ID of the landlord along
with declaration and Tenant Police Verification
4. Registration Certificate and Stay Visa : FRRO/ FRO Registration Certificate and Stay Visa (if any)
5. Passport : Bio-Data page of Passport along with page bearing last Indian Immigration arrival stamp
6. Financial resource proof : NRO account details and Scholarship letter (if any)
7. Bonafide certificate : Bonafide Certificate to be obtained from a UGC or AICTE recognized Institute/College/University mentioning Foreign Students’ Information System (FSIS) No.,
course undertaken, duration of course and e-mail ID of the Institute/College/University
8. Registration Certificate : FRRO/FRO Registration Certificate/Residential Permit of the Student (S-1) Visa holder
Registration office address
Office Name : FRO LUDHIANA
Address : CP, LUDHIANA,Ph-2414943 OR SSP OFFICE LUDHIANA RURAL,JAGRAON ,ph-224048
City/District : LUDHIANA
State : PUNJAB
Pin Code : 141001
Phone Number : 000000
Office opening time: 9.00 closing time: 16.00
There is no need to submit hard copy to concerned
FRRO/FRO
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