Paste your unsigned
recent color photograph.
Size: 2" X 2"
Visa Application Form
Signature
COLB00022121
A. Personal Particulars (As in Passport)
Surname (As in Passport) SANTOS ACEVEDO
Application Id : COLB00022121
Given Name (As in Passport) EUNICE
Previous/other Name if any Not Applicable
Gender FEMALE Marital Status SINGLE
Date of Birth 30-MAR-1958 Religion CHRISTIAN
Place of Birth Town/City ZAPATOCA Country of Birth COLOMBIA
Citizenship /National ID No COLOMBIAN Educational Qualification POST GRADUATE
Visible identification marks NONE
Current Nationality Nationality by Birth/
COLOMBIA Naturalization BY BIRTH
Any Other Previous/Past Nationality Not Applicable
B. Passport Details
Passport No. AS894702 Date of Issue ( dd/mm/yyyy ) 12-JUL-2016
Place of Issue BUENOS AIRES Date of Expiry ( dd/mm/yyyy ) 12-JUL-2026
Web Registration Date : 24-AUG-2021
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. Applicant's Contact Details
CARRERA 1 NO 70A-65
Present APTO102 Phone No 4721806
Address BOGOTA Mobile /Cell No 573114746548
DISTRITO CAPITAL, COLOMBIA
110231 Email address NICHESANTOS@[Link]
CARRERA 1 NO 70A-65 APTO
Permanent 102
Address BOGOTA
DISTRITO CAPITAL
D. Family Details
Relation Name Nationality Prev. Nationality Place/Country of Birth
CHARALA
Father's JOSUE ORLANDO SANTOS CAMACHO COLOMBIA COLOMBIA COLOMBIA
ZAPATOCA
Mother's EUGENIA ACEVEDO DE SANTOS COLOMBIA COLOMBIA COLOMBIA
Marital
Status Single
Were your Grandfather/Grandmother(Paternal/Maternal) Pakistan Nationals Or belong to Pakistan held area : NO
EUNICE SANTOS ACEVEDO
E. Details of Visa Sought (Visa shall be valid from the Date of Issue and not from the Date of Journey)
Type Of Visa Required ENTRY VISA No of Entries MULTIPLE
Period of Visa ( Month) 6 Month Expected Date of Journey 04-SEP-2021
Port Of Arrival NEW DELHI Port of Exit NEW DELHI
Required Detail of ENTRY VISA
Purpose of Visit : FOR THOSE CATEGORIES FOR WHICH X-MISC VISA HAS BEEN SPECIFIED IN VARIOUS
CHAPTERS OF THE VISA MANUAL AND FOR PURPOSES WHICH ARE NOT COVERED BY ANY OTHER VISA
CATEGORY
F. Previous Visit Details
Have You Ever visited India ? NO
Address where You stayed in
India ,
Cities in India Visited
Type of Visa Visa Number
Visa Issued Place Date of Issue
Countries visited in last 10
years ARGENTINA, ECUADOR, CHILE,PANAMA
Have you been refused an Indian Visa or extension of the same previously or deported
Application Id : COLB00022121
from India ? NO
G. Profession/Occupation Details :
AGREGADA CULTURAL EN
Present Occupation RETIRED Designation/Rank BUENOS AIRES
Employer name/business MINISTERIO DE RELACIONES EXTERIORES
Employer Address CALLE 10 NO 5-51
Phone Number 5713814000
Past occupation if any RETIRED
Are/have you worked with Armed forces/ Police/ Para Military forces ? NO
Organization Designation
Place of Posting Rank
H. Details of Two Reference
In India In COLOMBIA
Name VIPUL ARORA EDGAR RUIZ RUIZ
Address 5 CH 8 JAWAHAR NAGAR AV CIRCUNVALAR NO 83-29
JAIPUR JAIPUR RAJASTHAN
Phone Number 919928339900 57 3176367180
I. DECLARATION
a. I do not hold any other passport(s) other than those detailed above.
b. I have read and understood all the conditions for the visit to India and I am willing and able to abide fully by them.
c. 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.
d. 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.
24-AUG-2021 ................................
Date : ...................... Applicant's signature (as in Passport)