KHC/ND/VISITOR/ *

Registration Form
(To be completed by Kenyan Students)


Sur Name

Other Name *

Date of Birth *


Permanent Address in Kenya


Box No. *

Landline *

Fax No. *

Email *

Country *

Location *

Sub Location *

Village *


Travel Document


Passport Number *

Issued at Location *

Issued On Date *

Date Of Expiry *

Immigration File No. (R)


Purpose of Visit:


Date Of Arrival in India *

City

Hotel

Hotel Tel No

Purpose

Expected Date of Return


Father's Details & Address in Kenya


Name

Occupation

Box No

LandLine no

Fax No

Email


Give Particulars Of Any Other Two Person Who May be Contacted in Case Of an Emergency:


Name

Relation

Contact Address

Landline

Cell No.

Fax No.

Email

Name

Relation

Contact Address

Landline

Cell No.

Fax No.

Email

Date

NOTES
(a)Please fill all the boxes to submit successfully
(b)Please note that it is strongly advised that all Kenyan nationals register with the Mission Upon arrival in India, Bangladesh, Singapore and Sri Lanka.