भारत सरकार

Government of India

High Commission of India

Kuala Lumpur, Malaysia

For Indian Citizens

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Full Name with alias if any (in block letters) :
Place & Date of Birth* :
Profession or Occupation :
Education qualification with Specialised subject, if any :
Father's Name and address :
Permanent address in India :
Telephone :
Education qualification with Specialised subject, if any* :
Email address :
Whether Married/Single/Widow/Widower/Divorced :
Passport Number, Date and Place of issue :
Name and Address, Profession or Occupation and Nationality of Wife :
Number, Date and Place of Issue of Wife / Husband's Passport* :
Particulars of Dependants / Minors, If any :
Name and Address of two Closes Relatives in India :
Name and Addresses of the University / Institution where Working /Employed :
Date of arrival in Malaysia Address and Telephone Number lf any :
Probable Period of Stay in Malaysia :
Probable Date of Leaving Malaysia & Destination :
Probable Date of Returning to India :