1. Type of Visa Applied for: Diplomatic Official Military Business Tourist Family Transit Journalist Others Please Specify:

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1 Consulate General of Pakistan Chicago 333 N Michigan Ave, Suite 728, Chicago IL Tel: Ext 2008 fax: info@pakistanconsulatechicago.org (Please read these instructions carefully before filling in the application form) 1. No column should be left blank. Incomplete forms with vague entries will not be accepted. Where applicable copies of supportive documents should be submitted along with the application form. 2. Applicants may use extra sheets, in case of in sufficient space in the form. 3. Normal Processing time for Visas is 4-6 Weeks. 4. Applicants may be asked to appear for an interview if required. 5. On arrival, immigration formalities are mandatory. (police registration is applicable in certain cases) 6. Attach bank statement for business visit. 7. Applicants family includes spouse, son, daughter, father, and mother. 8. Use BLACK INK ONLY and write in BLOCK CAPITAL ONLY PART 1 1. Type of Visa Applied for: Diplomatic Official Military Business Tourist Family Transit Journalist Others Please Specify: 2. Purpose of Visit: 3. Duration of Stay: 4. Visa required for: Less than 01 Month 06 Months 1Year 2Years 5Years 5. Type of Visa Single Double Multiple i. Port of Entry ii. Port of Departure iii. Places to be visited in Pakistan a b c d 6. Section I (Applicants Details) i. Name as in Passport: ii: Date of Birth First Middle Last dd / mm / yyyy iii: Place of Birth: City: Country: iv: Sex: Male Female v. Blood Group vi: Marital Status: Single Married vii: Identification Mark: viii: Native Language: ix: Nationality: a.present b.previous c.dual x. Religion: xi: PASSPORT DETAILS: Type of Passport: Diplomatic Official / Service Ordinary UN Travel Document Passport Number Place of Issue Date of issue Photograph must be: Date of Expiry Issuing Authority Passport size 2x2 Recent and true likeness, showing full face, with no hat, helmet or sunglasses. Although reading/sight glasses may be worn

2 xii: ADDRESS & a. Abroad/ Country of Origin: Telephone: Home Work Cell b. In Pakistan Telephone: Home Work Cell xiii: Is your Visit Sponsored? Yes (if Yes please give details) No Name of Sponsor Address Contact Number Home Work Cell xiv: Details of Profession: (Please specify Rank/Service, in case of Armed Forces / Uniform Personnel) a: Note: In case of Military Services, please fill in the attached Performa. xv: b: Employer s / Sponsor s Details (In pakistan / Abroad If applicable). Name Address Telephone Cell: Work: Home: Details of Jobs held in the past: a. Designation b. Department c. Duration(from-to) d. Duties e. Address & Phone No. f. Name, address and contact details of immediate Head/any other colleague: Use extra sheet if required xvi: Are you applying for a visa from a third country? Yes No If yes, please provide a copy of Residence / Work permit of that Country 7. SECTION II (FAMILY DETAILS) i. Name of Mother ii. Mother s Nationality iii. Name of Father iv. Father s Nationality v. Spouse Details: Name Nationality Date & Place of Birth Profession Name, address & contact details of employer of spouse (if any) - 2 -

3 vi. Do you have any children? Yes (If yes please provide details of each child) No Name (First, Middle, Last) Date of Birth (mm/dd/yyyy) vii. Please list any of accompanying person / family member (including children) traveling with you to Pakistan. Full Name Date of Birth Passport Number Address viii. Do you have any Bank Accounts in Pakistan? Yes (If yes please provide details) No Bank Name Branch A/C Number Address Verifier Details 8. TRAVEL HISTORY: i. Have you ever visited Pakistan during the last five years? Yes (If yes please provide details) No Date Destination / Address Purpose Duration ii. Details of other Countries visited during the last 2 years Date Destination / Address Purpose Duration iii. Have you ever been refused a visa for any country including Pakistan? Yes No - 3 -

4 iv. Have you ever been refused entry on arrival to Pakistan? Yes (If yes please provide details of refusal) No v. Have you ever been deported, removed or otherwise required to leave any country, including Pakistan? Yes (If yes please provide details) No Date Country Reason Reference Number (For Pakistan) vi. Do you have any criminal convictions or charged in any country? Yes (If yes please provide details) No Date Country Offence Sentence DECLARATION: I declare that the information given in this form is correct to the best of my knowledge and belief and if any of the particulars furnished above are found to be incorrect or withheld the visa is liable to be rejected / cancelled at any time. Date Signature of the Applicant - 4 -

5 PART - II Processing Certification (For Official Use ONLY NOT TO BE FILLED BY THE APPLICANT) 1. Date of receipt of Visa Application 2. Registration Number 3. Visa Fee Received 4. Additional Documents received a. b. c. d. 5. Particulars of the official who checked the visa form for its correctness and supporting documents a. Name b. Designation c. Date d. Signature 6. Details of clearance received from Ministry of Interior: No: Date 7. Decision by Officer in charge a. Accepted b. Regretted c. Type of Visa Issued d. Duration e. Single Entry f. Multiple Entries g. Number of Entries DATE: (Signature of Visa Issuing Authority) - 5 -

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