eMedical attendant visa application
- Applicant Details Form
- Visa Details Form
- Additional Question Details
- Upload Photograph
- Document Upload
- Confirm Details
| Passport Type * |
ORDINARY PASSPORT OFFICIAL PASSPORT DIPLOMATIC PASSPORT SERVICE PASSPORT SPECIAL PASSPORT |
|---|---|
| Nationality/Region * | |
| Port Of Arrival * | |
| Date of Birth * | (DD/MM/YYYY) |
| Email ID * | |
| Re-enter Email ID * | |
| Expected Date of Arrival * | (DD/MM/YYYY) |
| Visa Service *
eMEDICAL VISA SHORT TERM MEDICAL TREATMENT OF SELF eBUSINESS VISA TO SET UP INDUSTRIAL/BUSINESS VENTURE SALE/PURCHASE/TRADE ATTEND TECHNICAL/BUSINESS MEETINGS TO RECRUIT MANPOWER PARTICIPATION IN EXHIBITIONS,BUSINESS/TRADE FAIRS EXPERT/SPECIALIST IN CONNECTION WITH AN ONGOING PROJECT CONDUCTING TOURS TO DELIVER LECTURE/S UNDER GLOBAL INITIATIVE FOR ACADEMIC NETWORKS (GIAN) eCONFERENCE Visa O ATTEND A CONFERENCE/SEMINAR/WORKSHOP ORGANIZED BY A MINISTRY OR DEPARTMENT OF THE GOVERNMENT OF INDIA,STATE GOVERNMENTS OR UT ADMINISTRATIONS AND THEIR SUBORDINATE/ ATTACHED ORGANIZATIONS AND PSUS AND PRIVATE CONFERENCES ORGANIZED BY PRIVATE PERSONS/COMPANIES/ORGANIZATIONS. eMEDICAL ATTENDANT VISA TO ACCOMPANY PATIENT TRAVELLING TO INDIA ON EMEDICAL VISA |
I have read the instructions ,I have all the required documents in scanned pdf format and photograph in jpg/jpeg format.
While entering India, Covid related measures shall be applicable as per guidelines issued by Govt of India from time to time.
Note: Following documents are required to be submitted
1) Applicant's recent colored photograph (dimensions 2in X 2in) size less than 1MB
2) Copy of Passport page containing personal particulars
3) Invitation from organizer
4) Political clearance from Ministry of External Affairs (MEA), Government of India
5) Event clearance from Ministry of Home Affairs (MHA), Government of India
Applicant Details Form
Port of Arrival :
Data saved Successfully.Please note down the Temporary Application ID :
Applicant Details
| Surname (exactly as in your Passport) | Surname/Family Name (exactly as in Passport) |
|---|---|
| Given Name/s (exactly as in your Passport) * | Given Name/s (exactly as in Passport). |
| Have you ever changed your name? If yes, click the box and give details. | If You have ever changed your Name Please tell us. |
| Previous Surname * | Previous Surname |
| Previous Name * | Previous given name |
| Gender *
Male Female Transgender |
Gender |
| Date of Birth * | Date of Birth as in Passport in DD/MM/YYYY format |
| Town/City of birth * | Province/Town/City of birth |
| Country/Region of birth * | Country/Region of birth |
| Citizenship/National Id No. * | If not applicable Please Type NA |
| Religion *
BAHAI BUDDHISM CHRISTIAN HINDU ISLAM JAINISM JUDAISM OTHERS PARSI SIKH ZOROASTRIAN |
If Others .Please specify |
| Visible identification marks * | Visible identification marks |
| Educational Qualification *
BELOW MATRICULATION GRADUATE HIGHER SECONDARY ILLITERATE MATRICULATION NA BEING MINOR OTHERS POST GRADUATE PROFESSIONAL |
Educational Qualification |
| Nationality/Region * | Nationality/Region |
| Did you acquire Nationality by birth or by naturalization? *
By birth Naturalization |
Did you acquire Nationality by birth or by naturalization? |
Have you lived for at least two years in the country where you are applying visa?
Yes No
Passport Details
| Passport Number * | Applicant's Passport Number |
|---|---|
| Place of Issue * | Place of Issue |
| Date of Issue * | In DD/MM/YYYY format |
| Date of Expiry * | In DD/MM/YYYY format.Minimum Six Months Validity is Required from journey date. |
| Any other valid Passport/Identity Certificate(IC) held,
If Yes Country of Issue * Passport/IC No. * Date of Issue * Place of Issue * Nationality mentioned therein * |
Yes No |
Applicant's Address Details
| House No./Street * | Applicant's Present Address. Maximum 35 characters (Each Line) |
|---|---|
| Village/Town/City * | Village/Town/City |
| Country * | Country |
| State/Province/District * | State/Province/District |
| Postal/Zip Code * | Postal/Zip Code |
| Phone No. | One Contact No is Mandatory |
| Mobile No. | Mobile number. |
| Email Address |
Permanent Address
| House No./Street * | Applicant's Permanent Address(with Postal/Zip Code) |
|---|---|
| Village/Town/City | Village/Town/City |
| State/Province/District | State/Province/District |
Family Details
Father's Details
| Name * | Applicant's Father Name |
|---|---|
| Nationality/Region * | Nationality/Region of Father |
| Previous Nationality/Region | Previous Nationality/Region of Father |
| Place of birth * | Place of birth |
| Country/Region of birth * | Country/Region of birth |
Mother’s Details
| Name * | Applicant's Father Name |
|---|---|
| Nationality/Region * | Nationality/Region of Father |
| Previous Nationality/Region | Previous Nationality/Region of Father |
| Place of birth * | Place of birth |
| Country/Region of birth * | Country/Region of birth |
| Applicant's Marital Status *
Single Married |
Applicant´s Maritial Status |
| Were your Parents/Grandparents (paternal/maternal) Pakistan Nationals or Belong to Pakistan held area. | Were your Parents/Grandparents (paternal/maternal) Pakistan Nationals or belong to Pakistan held area? Yes / No |
| If Yes, give details | If Yes, give details |
Profession / Occupation Details of Applicant
| Present Occupation * | If Others,please specify |
|---|---|
| Employer Name/business * | Employer Name / Business |
| Designation | Designation |
| Address * | Address |
| Phone | Phone No |
| Past Occupation, if any | Past Occupation, if any |
| Are/were you in a Military/Semi-Military/Police/Security. Organization?
Yes No |
If yes,give details |
| Organization * | Organization |
| Designation * | Designation |
| Rank * | Rank |
| Place of Posting * | Place of Posting |
Visa Details Form
| Details of Visa Sought | |
|---|---|
| Type of Visa * | |
| Visa Service * | |
| Places to be visited * | If you intend to visit Protected/Restricted/Cantonment areas, you would require prior permission from the Civil Authority. |
| Places to be visited line 2 | |
| Have you booked any room in Hotel/Resort etc. through any Tour Operator?
Yes No Name of the tour operator Address of the tour operator Name of Hotel/Resort etc Place/City of Hotel/Resort etc |
If Yes |
| Details of Purpose "TO ACCOMPANY PATIENT TRAVELLING TO INDIA ON EMEDICAL VISA" | |
| Name of the Hospital where Medical treatment is to be carried out | |
| Name of the principal e-Medical Visa holder (i.e. the patient) | |
| Visa No. / Application id of principal e-Medical Visa holder | |
| Visa No. | |
| Application Id | |
| Visa/Application number of principal e-Medical Visa holder | |
| Passport number of principal e-Medical Visa holder | |
| Date of birth of principal e-Medical Visa holder | Please enter date of birth |
| Nationality of principal e-Medical Visa holder | |
| Duration of Visa * | Duration of visa is 60 days |
| No. of Entries * | No. of Entries |
| Port of Arrival in India * | Port of Arrival in India |
| Expected Port of Exit from India | Expected Port of Exit from India |
| Previous Visa/Currently valid Visa Details | |
|
Have you ever visited India before? *
Yes No |
If Yes Please give Details |
| Address * | Enter the address of stay during your last visit |
| Cities previously visited in India * | Cities in India visited (comma separated) |
| Last Indian Visa No/Currently valid Indian Visa No. * | Last Indian Visa no / Currently valid Visa no |
| Type of Visa *
BUSINESS VISA CONFERENCE VISA DIPLOMATIC VISA DOUBLE ENTRY EMPLOYMENT VISA ENTRY VISA e-Visa FILM VISA JOURNALIST VISA MEDICAL VISA MISSIONARY VISA MOUNTAINEERING VISA OFFICIAL VISA PILGRIMES VISA STUDENT VISA TRANSIT VISA UN DIPLOMAT UN OFFICIAL VISIT VISA |
|
| Place of Issue * | Place of Issue |
| Date of Issue * | Date of Issue in (DD/MM/YYYY) format |
| Has permission to visit or to extend stay in India previously been refused? * Yes No |
Refuse Details Yes /No |
| If so, when and by whom (Mention Control No. and date also) * | If so, when and by whom (mention Control no and date) |
| Other Information | |
| Countries Visited in Last 10 years | If information furnished is found to be incorrect at the time of entry or anytime during stay in India, you will be refused entry. |
| SAARC Country Visit Details | |
| Have you visited SAARC countries (except your own country) during last 3 years? Yes No |
Have you visited "South Asian Association for Regional Cooperation" (SAARC) countries (except your own country) during last 3 years? Yes /No |
| Reference | |
| Reference Name in India * | Reference Name and Address in India |
| Address * | |
| Phone * | Phone No. |
| Reference Name in ANDORRA * | Please mention one contact details in Home Country to be contacted in case of emergency |
| Address * | |
| Phone * | Phone No. |
Additional Question Details
1. Have you ever been arrested/ prosecuted/ convicted by Court of Law of any country? *
Yes No
If yes
Please give details
2. Have you ever been refused entry / deported by any country including India? *
If yes
Please give details
3. Have you ever been engaged in Human trafficking/ Drug trafficking/ Child abuse/ Crime against women/ Economic offense / Financial fraud? *
If yes
Please give details
4. Have you ever been engaged in Cyber crime/ Terrorist activities/ Sabotage/ Espionage/ Genocide/ Political killing/ other act of violence? *
If yes
Please give details
5. Have you ever by any means or medium, expressed views that justify or glorify terrorist violence or that may encourage others to terrorist acts or other serious criminal acts? *
If yes
Please give details
6. Have you sought asylum (political or otherwise)in any country? *
If yes
Please give details
IUAJU, hereby declare that the information furnished above is correct to the best of my knowledge and belief. in case the information is found false at any stage, I am liable for legal action/deportation/blacklisting or any other action as deemed fit by the Government of India.
Upload Photograph
Choose the Photo To Upload
Temporary Application Id:-AX22A7297W8C3WC
Kindly ensure that the photo is as per specifications mentioned below.
In case you are not ready for photo upload you can do it later, Please note down the Temporary Application Id ,close the window and Press Save and Exit .
You can complete your application later using Complete Partially Filled Form option on home page.
Photo Specifications
- Format JPEG
- Size Minimum 10 KB , Maximum 1 MB
- The minimum dimensions are 350 pixels (width) x 350 pixels (height).
- Recent front facing photograph with white background to be uploaded by the applicant.
- Do not crop the Passport Image to use it as your recent photograph. Upload clear front facing photograph with preferable white/light coloured background.
- The application is liable to be rejected if the uploaded photograph are not clear and as per specification.
Document Upload
Document to be uploaded for Temporary Application Id:-AX22A7297W8C3WC
Document description
1) Copy of Passport page containing personal particular
2) Copy of Letter from the Hospital concerned in India on its letterhead
Kindly ensure that the document is as per specifications mentioned below.
- All documents uploaded by the applicant including business cards,invitation letters etc. must be in English language, failing which e-Visa application would be liable for rejection.
- Format PDF
- Size Minimum 10 KB
- Maximum 300 KB
- Passport Upload- Photo page of Passport containing personal details like name,date of birth, nationality , expiry date etc. to be uploaded by the applicant.
- Photo page of Passport uploaded should be of the same passport whose details are provided in Passport Details section.
- The application is liable to be rejected if the uploaded document is not clear and as per specification.
I have verified that all the documents are uploaded as per the requirement.
Visa Details Form
Places to be Visited
Select State
Address of Relatives/business associates/ contact persons at places of visit
Name of Relatives /Business/ Sponsor contact person
Relation
H.No./Street/Mohallah
/Post Office
Village/ Town/City
State
District
Pin Code
phone No.
Address at Place of Stay
Place of Stay
Name and Address of Stay/Hotel
State
District
Telephone No.
Whether you intend to visit J&K Yes No
Do you or your parents by birth belong to any part of Jammu & Kashmir,Yes Yes No
Have you migrated from India to Pakistan on or after 1st March 1947,Yes Yes No
(i) Approximate Date of Migration
(DD/MM/YYYY)
(ii) Address in India before Migration:
Decision on Visa granting would be dependant on the accuracy of the information provided.
Confirm Details
The applicant is requested to verify the particulars filled in the application Form.The applicant may face legal action(including refusal to enter India or deportation) in case of provision of wrong information.
Please verify your Registration Details. If all details are correct please Press "Verified and Continue".
For any corrections press "Modify/Edit"
Please note down the Temporary Application ID: AX22A7297W8C3WC
