D. I. P Form-4(Free of cost)
Government of the People's Republic of Bangladesh
Department of Immigration & Passports
Machine Readable Visa Application Form
This Form Should Be Filled Up In 'Capital Letters'. Put
()
In Appropriate Box.
Please Go Through The General Instructions Before Filling Up The Visa From.
Name of Office/ Bangladesh Mission :
PERSONAL DETAILS
01. Full Name :
(as in the passport) First/ Given Name (S) Last/ Surname
02. Permanent address:
Contact no: E-mail:
03. Address in Bangladesh:
Contact no: E-mail:
04. Date of Birth: / / 05. Sex:
Male Female
Others
D D / M M / YYYY
06. Place of Birth: 07. Present Nationality:
08. Nationality at Birth: 09. Occupation:
10. Marital Status : Unmarried Married Widower/Widow Divorced
TRAVEL DOCUMENT DETAILS
11. Passport No: 12. Type of Passport
13. Place of Issue:
14. Date of issue: / / 15. Date of Expiry: / /
D D / M M / YYYY D D / M M / YYYY
16.
Date of last visit to Bangladesh: / /
D D / M M / YYYY
17. Last Visa No: 18. Date of Issue:
/ /
D D / M M / YYYY
19. Place of Issue: 20. Date of Expiry: / /
D D / M M / YYYY
PAYMENT DETAILS
21. Name of the Bank and Branch:
22. Cheque/ Bank Transfer/ Chalan/ Scroll No:
23. Amount deposited 24. Date: / /
(Taka/ US$)
D D / M M / YYYY
Applicant’s
Photograph
Measuring
45 mm x 35mm
NEW VISA
25. Purpose of Visit: Tourism Employment Business Official Diplomatic
Study Investment Transit Others
(Please Specify)
26. Duration of Proposed Stay in Bangladesh:
27. Tentative Date of Arrival in Bangladesh: / /
D D / M M / YYYY
28. Intended Number of Entries: Single Re Entry Multiple
EXTENSION OF VISA
29. Name of the Father/Mother/Spouse/ Other (Relation) :
30. Date of Arrival: / / 31.Visa No: 32.Type of Visa:
in Bangladesh
D D / M M / YYYY
33. Date of issue : / / 34. Date of Expiry : / /
D D / M M / YYYY
D D / M M / YYYY
35. Place of Issue:
36. Purpose of Extension of Visa:
37. Duration of Proposed Extension:
38. Intended Number of Entries: Single Re Entry Multiple
NO VISA REQUIRED FOR TRAVEL TO BANGLADESH
39. Father’s name : Nationality:
40. Mother’s name: Nationality:
41. Spouse’s name: Nationality:
42. Date of Arrival in Bangladesh : / / 43. Visa No:
D D / M M / YYYY
44. Date of Issue: 45. Date of Expiry:
D D / M M / YYYY D D / M M / YYYY
46. Place of issue: 47. Type of Visa:
48. Reason For Proposed NVR:
49. Amount of Investment (For Investor):
50. Name and Address of Company:
TRANSIT/ON ARRIVAL VISA
51. Date of Arrival in Bangladesh: / / 52. Name of check post:
D D / M M / YYYY
53. Travelled by (Vessel’s/ Flight/Vehicle Name & No): 54. From:
55. Purpose of Visit to Bangladesh: 56.Duration of Proposed Stay:
CHECK LIST
Recommendation from concern Ministry/ Authority Marriage Certificate
Security Clearance/Security Certificate Birth Certificate
Father’s/ Husband’s/Mother’s Visa Copy Work Permit
Passport copy, Last Visa & Last Arrival Page Affidavit
Father’s/ Husband’s/Mother’s Passport Copy Photo
N. O. C from Sri Lankan High Commission Income Tax Certificate of the Company
Bi- Lateral Agreement/ Multilateral Agreement TIN
Trade license of the sponsoring Company TIN certificate of the company
Payment Slip Over stay payment Slip Others
I, hereby, declare that statement given above is true and will not request to refund my paid visa fee even if my
application is declined.
Place
Date / / Signature
D D / M M / YYYY
POLICE VERIFICATION
Memo No
:
Date: / /
D D / M M / YYYY
Information’s are found:
If not correct: Reasons :
Signature and Seal of Inquiry Officer Signature and Seal of Issuing Officer
FOR OFFICIAL USE
Reference No: Date: Amount of
Fee
:
Visa No : Date: Date Expiry :
Number of Entries Extension Re- Entry Multiple Entries NVR
Recipient’s Signature: Authorized Signature
Date: Date & Seal
Correct
Incorrect
General Instructions
1. Attach a colour photograph (45mm x 35mm) with glue at the top left corner of the form.
Photograph has to be white background.
2. Personal details, Travel Document details, Payment details (as applicable) must be filled up.
3. Apply according to your necessity and fill up the required option of New visa/ Extention of visa/
Transit permit/ On arrrival visa/ No Visa Required (N.V.R)
4. Apply with essential documents, otherwise, the application would not be received for
consideration.
5. Use Tick mark (√) in the check Box.
6. Deposit the visa fee (if applicable) to the respective bank counter and attach payment receipt on
the top of the application form.
7. Receive delivery slip after the submission of application form and check the content of the
delivery slip before going out from the visa office.
8. Paid of visa fee is non-refundable.
9. Lodge your passport as per tentative call date for getting visa.
10. Reissuance of visa sticker due to applicant’s mistake needs to be paid again as per payment list.
11. In some cases, Visa call date subjects to police verification Report/ Security Clearance from
MOHA/ Work Permit from BOI/BEPZA/ N.G.O/ Bureau/ Recommendation from Ministry Or
organizations concerned,
12. The authority’s decision regarding visa is final.
