Online Form 'C'
ARRIVAL REPORT OF FOREIGNER IN INDIVIDUAL HOUSE
05 Nov 2019 Tue 14:44:18 PM
Welcome, Sturm041218 Individual House: Sturmfrei Last Login: 05-11-2019 14:46:15 PM Menu Logout Exit
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 Accomodation Details (Hotel/ DharamShala/ Guest House/ Lodge/ Individual House/ Institute etc.)  Photo 
Name : 
Sturmfrei
Address : 
House no. 167/2, Zhor Vaddo, Near St. Anthony Hospital, Anjuna, Bardez- 403509, Goa
State : 
GOA
City/District : 
GOA
Phone No : 

Mobile No : 
8849629033
 Personal Details
 		 Help
Photo

Kindly click "Upload File" after selecting the photograph
Maximum photo size limit is 50 KB as per the passport
Surname
For reducing photo size:Resize photo or set dpi or crop photo
Given Name * Photo must be in JPG format.
Sex * 
 
Date of Birth Date Format *
 Date of Birth (As per the passport)
Date of Birth *
If MM/YYYY is chosen, then Date is set
as 01/MM/YYYY
If YYYY is chosen, then Date is set as
01/01/YYYY
Age *
    (Age as on Today)   Real Date of Birth : If AGE is chosen, then Date of birth is set
as 01/01/(Current year - Age)
If AGE is less than One year it will show as 0(zero)
Special Category *  Choose Others always for general category
Nationality *  
 Address in country where residing permanently
Address in country where residing permanently *   As per the passport
City *
  City where residing permanently 
Country *  
 Address/Reference in India
Address/reference in India *  For Address/Reference in India
State *
 
City/District *
 
Pin Code *  
 Passport Details
Passport No *    In case of Nepali and Bhutani provide
Place of issue * 
 City       
 Country
  Identification Card Details and In case of Tibetan Refugee
  provide SEP/Registration Details
  In case of Loss Of Passport provide Emergency Certificate/
  Travel Document Details		  
Date of issue * 
     DD/MM/YYYY
Valid till  * 
     DD/MM/YYYY
 Visa Details
Visa 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
Type of visa *   
Visa Sub Type 
 
 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
Arrived from Place *    is arriving
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 *    No. of Days
 Other Details
Whether employed in India *  Yes No   Choose Yes or No
Purpose of Visit *    Choose Appopriate options
Next Destination *  Inside India Outside India  
State
City/District
Place
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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