Government of India

Government of India

Embarkation Card

(Please use Capital letters only)

1. Name Mr/Ms./Mrs._______________________

Surname _{___________________________________________}

_{Other Names_____________________________________________}

_{2.
Date of Birth (D/M/Y)____________________________________}

_{Place and Country of Birth________________________________}

_{________________________________________________________}

_{3.
Nationality: _____________________________________________}

_{4.
Passport No.:____________________________________________}

_{5.
Place of issue:___________________________________________}

_{6.
Date of issue (D/M/Y)____________________________________}

_{7.
Address in India:_________________________________________}

_{8.
Port of Disembarkation: __________________________________}

_{Flight No.:_______________________________________________}

_{Immigration
stamp}

_{Signature
of Passenger}

Note : The cards are just for the sample, numbered card will be provided at the place of the Embarkation