FORM OF APPLICATION TO BE FILLED IN BY ALIEN DESIRING TO EXTEND STAY IN INDIA Note.- If any of the particulars below are found to be incorrect or if any information is found to have been withheld the extension granted is liable to be cancelled at any time. ______________________________________________________________________________________ 1. (a) Name in full (Surname in capital) - _______________________________________ (b) Father's name - _______________________________________ _______________________________________________________________________________________ 2. Address in India.- (a) Permanent._________________________________________________________________________ (b) Present. ___________________________________________________________________________ _______________________________________________________________________________________ 3. Nationality .- _______________________________________________________________________________________ 4. Place and date of birth.- ________________________________ _______________________________________________________________________________________ 5. Profession or present occupation.- _________________________________________________ _______________________________________________________________________________________ 6. Number and date of passport and the date upto which it is valid.- _________________________________ _______________________________________________________________________________________ 7. Number and date of visa for India and where issued.- __________________________________________ _______________________________________________________________________________________ 8. Date and place of arrival in India.- _________________________________________________________ _______________________________________________________________________________________ 9. Purpose of vist to India.- _________________________________________________________________ _______________________________________________________________________________________ 10. Whether resident in India previously, and if so, for what period.- ________________________________ _______________________________________________________________________________________ 11. Date of expiry of authorised period of residence in India.- _____________________________________ _______________________________________________________________________________________ 12. Period for which extension is required.- ____________________________________________________ _______________________________________________________________________________________ 13. Whether permission to extend stay in India has been granted/refused previously and, if so,when.- _______________________________________________________________________________________ 14. Reasons for extension of stay. (The reasons should be started fully in details. Failure to do so may result in delay or refusal of request, In case of missionaries the exact nature of work on which engaged should also be stated.- _______________________________________________________________________________________ 15. Name and address of persons of India who furnished financial guarantees for maintenance and repatriation on behalf of the applicant when he entered India.- ______________________________________________________________________________________ Signature _____________________ Date _________________________ Recommendation of the Commissioner of Police or the relevant Police Authority Recommendation of the State Government Note :- This application should be forwarded to the Government of India as soon as possible after their submission but not later than a week in any case.
