If retired please provide the occupation and company name prior to retirement :

If housewife, please provide spouse’s occupation with company or business with address:

~please provide parents’ occupation with address for infants, minors and students

Father’s name:
Father’s nationality :
Country and state of birth:

Mother’s name:
Mother’s nationality:
Country and state of birth:

Spouse’s name:
Spouse’s nationality:
Country and state of birth:

Tentative date of travel:
Port of arrival:
Location in India:
Contact number:

In case of emergency:
Contact person with phone number and address in Malaysia:
Contact person with phone number and address in India:

Have you been to India before?
Please provide a photocopy of the last visa issued .

*Provide (2) photos with white background. Size 2 by 2
IC photocopy