Embassy of India, Belgium, Luxembourg & European Union

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* Name (as in passport)

* Name of Father

* Passport No.

* Date of Issue

* Date of Expiry

* Profession

* Purpose of Stay

* Date of Arrival

* Proposed period of stay (in case of short term visit)

* Contact Address

* Tel. Number (Local Contact Number):

* Email:

* Alternate contact number (Local Contact Number) in case of Emergency:

Verification Code

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Embassy

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