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Form C
Thank you for filling out Form C. We will respond to you shortly.
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Accomodation Details (Hotel/ DharamShala/ Guest House/ Lodge/ Individual House/ Institute etc.)
*Name
--- Select ---
Magic Valley
*Address
--- Select ---
House No - 12 / 258, Chilanthiyar Masalakada, Kottakamboor P.O, Vattavada, Munnar
*State
--- Select ---
KERALA
*City/District
--- Select ---
IDUKKI
*Phone No
--- Select ---
8301982500
*Mobile No
--- Select ---
9645001133
Personal Details
Photo
Kindly click "Upload File" after selecting the photograph Maximum photo size limit is 50 KB as per the passport. For reducing photo size:Resize photo or set dpi or crop photo. Photo must be in JPG format.
doc,docx,mpg,mpeg,mp3,mp4,odt,odp,ods,pdf,ppt,pptx,txt,xls,xlsx
Surname
*Given Name
*Sex
--- Select ---
Male
Female
Transgender
*Date of Birth Date Format
--- Select ---
Date of birth in DD/MM/YYYY
*Date of Birth
DD/MM/YYYY
*Age
*Special Category
Choose Others always for general category
--- Select ---
Crew
Diplomat Exempted
Emergency Transit
Loss of Passport
Newly Born
OCI
Official Exempted
Other Exempted
Others
PIO
Refugee
TLP
*Nationality
Address in country where residing permanently
*Address in country where residing permanently
*City
*Country
Address in country where residing permanently
*Address/reference in India
*State
*City/District
*Pin Code
Passport Details
*Passport No
In case of PIO/OCI/CREW/TLP provide PIO/OCI/CREW/TLP Details
Place of issue
*City
*Country
*Date of issue
DD/MM/YYYY
*Valid till
DD/MM/YYYY
Visa Details
*Visa No
Place of issue
*City
*Country
*Date of issue
DD/MM/YYYY
*Valid till
DD/MM/YYYY
*Type of visa
--- Select ---
BUSINESS VISA
CONFERENCE VISA
CONFERENCE VISA
DIPLOMATIC DEPENDENT VISA
DIPLOMATIC VISA
DOUBLE ENTRY VISA (ONLY FOR BANGLADESH NATIONALS)
e-Emergency X-Misc Visa
EMPLOYMENT VISA
ENTRY VISA
e-VISA
FILMS VISA
JOURNALIST VISA
LONG TERM VISA
MEDICAL VISA
MISC SP PERMISSION
MISSIONARY VISA
MOUNTAINEERING VISA
OCI
OFFICIAL DEPENDENT VISA
OFFICIAL VISA
PIO CARD HOLDER
PLIGRIM VISA(ONLY FOR PAKISTAN NATIONALS)
STUDENT VISA
TEMPORARY LANDING PERMIT
TOURIST VISA
TRANSIT VISA
UN DIPLOMAT VISA
UNITED NATION
UN OFFICIAL VISA
VISA-ON-ARRIVAL
VISITOR VISA(ONLY FOR PAKISTAN NATIONALS)
*Visa Sub Type
--- Select ---
C-1 - [Participant of conferences organized by government authorities]
C-2 - [Participant of conferences organized by non-government authorities]
Arrival Information
*Arrived from Country
Country from where He/ She is arriving to India
*Arrived from City
City/ Place of above country from where He/ She is arriving
*Arrived from Place
*Date of Arrival in India
DD/MM/YYYY
*Date of Arrival in Individual House
DD/MM/YYYY
*Time of Arrival in Individual House
HH:MM (24 Hours format i.e 10:30 PM = 22:30)
*Intended duration of stay in Individual House
Other Details
*Whether employed in India
YES
NO
*Purpose of Visit
--- Select ---
Accompanying Parents
Accompanying Patient
Accompanying Patient as Doctor
Accompanying Spouse
Business
Diplomatic
Education
Employment
Internship
Joining spouse
Journalism
Medical Treatment of self
Meeting friends/relatives
Minor child(either parent is Indian)
Official
Others
Seminar/conference in India
Studies
Surrogacy
Tourism
*Next Destination
Inside India
Outside India
*State
*City/District
*Country
Contact Phone No (In India )
Mobile No (In India )
Contact Phone No (Permanently residing Country )
Mobile No (Permanently residing Country )
Remarks (If any)
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