MINISTRY OF FOREIGN AFFAIRS
PROTOCOL DIVISION
THIMPHU

VISA APPLICATION FORM

(Please fill in block capital letters)

NOTE: If any particulars furnished are found to be incorrect or if information is found to have been withheld, the visa if granted is liable to be cancelled at any time.

1.	Full Name Mr./Mrs./Ms. ___________________________________________________

2.	Permanent Address: _______________________________________________________

3.	Place of Birth: ________________________ Date of Birth: _______________________

4.	Nationality: _________________________________	

5.	Nature of Passport: Diplomatic/Official/Ordinary/UN Laisser - Passer

6.	Passport Number: ____________________ Date of Issue: _________________________

Place of Issue: ______________________ Date of Expiry: ________________________

7.	Occupation/Profession: ___________________________________________________

8.	Period for which visa is required: ____________________________________________

9.	Point of entry/exit into Bhutan	Entry: ______________________________________

					Exit: ______________________________________

10.	Purpose for visiting Bhutan:  _______________________________________________

11.	Is this your first visit to Bhutan?  YES/NO. If not, give details of your earlier visit(s):
_______________________________________________________________________

Place: __________________________Date: _______________________________

________________________________
SIGNATURE OF THE APPLICANT

(Please delete whichever is not applicable)   
For Official use only.

Type of Visa: _____________________	Visa Number: __________________________________

Date of Issue: __________________________Visa clearance Number: _____________________