Visa - Concierge Service                                                                                     (Personal Information Form)
This form is to advise Visa And More that you are requesting the complete Visa documentation.  In order to properly process your request, please submit this form and submit your other documents as per the check list.  The applicant do solemnly and sincerely declare that the particulars stated here are true, and the applicant make this solemn declaration conscientiously believing the same to be true.  

Visa And More Concierge Service provides you a Concierge Specialist to manage the entire application process including document preparation and review, upgraded shipping, priority submission and more beginning within 4 business hours of your request. It's a complicated world out there. Let us simplify it for you.

From start to finish, you are assigned a Concierge Specialist, making sure all complications are minimized and that every document is prepared correctly.  Concierge Specialist ensures that every step of the process is being watched and that you can go about your day with confidence that your passport and/or visa request is in the best possible hands. Once a request is made, Visa And More's Concierge Service begins by assigning a dedicated Specialist who will reach out to you to discuss your needs and make the process as simple, quick and hassle free.

Additional Concierge Service Highlights:

Assistance with document preparation and review to minimize any rejections or delays;
Application forms completed and delivered for signature;
Secondary personal review of all documents prior to submission;
Review and recommendation of most appropriate visa and service level based on needs;
Personalized updates during all phases of the process via preferred method of contact;
Visa And More Concierge Service — Additional fee per traveler: $195 in addition to Foreign Embassy/Consulate Fees.
$75 per additional destination/service.

For questions  :  Call 832-413-3669 OR Email : services@thevisaandmore.com
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Email *
1. Nationality
1.1 Date of Birth *
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1.2 Expected Date of Departure *
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1.3 Expected Date of Arrival *
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1.4 Type of Visa Sought
Clear selection
1.5 Purpose of Visit
2. Surname (Last Name as per your PASSPORT) *
2.1 Given Full Name (First name and Middle name as per your PASSPORT) *
3. Sex *
4. Town/City of Birth *
4.1 Country of Birth *
5. Driving License/ID No. (If not applicable please type NA) *
6. Religion *
6.1 Religion (if selected Others as answer to 6 above, type your religion ) *
7. Visible Identification Marks *
8. Educational Qualification *
9. Did You Acquire Current Nationality By *
9.1 Date of Acquiring Current Nationality *
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9.2 Previous Nationality *
10. Current Passport Number *
10.1 Place of Issue
10.2 Date of Issue *
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10.3 Date of Expiry *
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11. Any other Country's valid Passport/Identity Certificate Held *
11.1 If yes, give the name of the Country, Date of Issue, Place of Issue and NATIONALITY mentioned therein
11.2 Date of Becoming Citizen of Any Other Country (if any, other than USA)
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12. Present Address *
12.1 Permanent Address
12.2 Home Phone No.
12.3 Mobile/Cell Phone No. *
13. Father's Name (as in his passport)
13.1 Father's Current Nationality *
13.2 Father's Previous Nationality *
13.3 Father's Place/City of Birth
13.4 Father's Country of Birth
14. Mother's Name (as in her passport)
14.1 Mother's Current Nationality *
14.2 Mother's Previous Nationality *
14.3. Mother's Place/City of Birth
14.4 Mother's Country of Birth
15. Marital Status *
16. Spouse's Name (as in passport)
16.1 Spouse's Current nationality *
16.2 Spouse's Date of acquiring current nationality (if naturalized)
16.3 Spouse's Previous Nationality *
16.4 Spouse's previous country's Passport Number
16.5 Spouse's Date of Birth
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16.6 Spouse's Place/City of Birth
16.7 Spouse's Country of Birth
17. Were Your Grandfather/Grandmother (Paternal/Maternal)Pakistan Nationals or Belong to Pakistan Held Area: *
17.1 If YES, provide Your Paternal Grandfather's Name
17.2 Your Paternal Grandfather's Current Nationality
17.3 Your Paternal Grandfather's Previous Nationality
17.4 Your Paternal Grandmother's Name
17.5 Your Paternal Grandmother's Current Nationality
17.6 Your Paternal Grandmother's Previous Nationality
18. Your Occupation/Business
18.1 Your Employer's/Business Address (in case of minor or housewife FATHER'S OR SPOUSE'S job/business information/address to be given). If retired, information of your last employer is required: *
18.2 Your Employer's/Business Phone Number
19. Are/were you in a Military/Semi-Military/Police/Security Organization?
Clear selection
19.1 IF YES, please give the Name of Organization, your Designation, Rank and Place of Posting  
20. Places Likely to be Visited *
21. Period of Visa *
21.1 Number of Entries
Clear selection
22. Port of Landing in the country of visit *
22.1 Port of Departure from the country of visit
23. Have You Visited the Country for Which Visa Applied For Now? *
23.1 If yes,  provide the (i) Address where you stayed
(ii) Cities previously visited *
23.2 Please give the details of previous visa.  Type of visa granted: (if applying for first time, select NA) *
23.3 Visa Number
23.4 Place of Issue
23.5 Date of Issue
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23.6 Have you been refused a visa or extension of the same previously or deported from the country for which you are applying visa now? *
24. Countries visited in last 10 years (please give the names of the countries) *
24.1 Have you visited any one or more countries listed herein in last 3 years *
Required
24.2 If YES, answer the following, If NO skip to question number 25 *
24.3 Name(s) of the Country
24.4 Year in which visited
24.5 Number of Visits
25. FIRST References' NAME/HOTEL NAME (In the Country You Plan To Visit) *
25.1 Address of Reference/HOTEL (In the country you plan to visit) *
25.2 Phone Number of Reference/HOTEL (In the country you plan to visit) with country/area code *
26. SECOND Reference NAME, (in the USA or your home country in case of non-US passport holder) *
26.1 Address of Reference (In USA or your home country in case of non-US passport holder) *
26.2 Phone Number of Reference (In USA or your home country in case of non-US passport holder) with country/area code *
Complete this section if applying for Renunciation/Surrender of previous Citizenship now, otherwise select "NO" for Question No.27 below and proceed to Question No.40)
27.I am applying for Renunciation? *
28. Have you ever held any other Country's / Indian Passport?
Clear selection
28.1 Have you renounced your previous/Indian Citizenship?
Clear selection
28.2 Have you applied for Renunciation of your previous/Indian Citizenship?
Clear selection
28.3 Do you have your most recent previous/Indian passport in your possession?
Clear selection
29. Date of Naturalization/current Citizenship
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30. Expiration Date of most recent previous/Indian Passport
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31. Have you used the previous/Indian Passport for travel that originated 3 months after the naturalization date?
31.1 Was your previous/Indian Passport renewed / reissued after acquiring foreign passport?
31.2 Have you availed any consular defined miscellaneous services on your retained / not surrendered passport after acquiring citizenship of another country?
32. Have you ever changed your name?
Clear selection
32.1 Do you have proof for Name Change?
Clear selection
33. Given Name (As given in Indian Passport)
33.1 Last Name (As given in Indian Passport)
34. Date of Birth
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35. Nationality at Birth
36. U.S./Foreign Passport Number
36.1 Date of Issue
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37. Most recent Indian Passport Number
37.1 Date of Issue
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37.2 Date of Expiry
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37.3 Place and Country of Issue
38. Permanent Address in India
39. Do you have Minor Children, who are / were Citizens of India?
Clear selection
Additional Personal Information
Please provide below given details.  Please give details if marked YES.
40.1 Have you ever been arrested/ prosecuted/ convicted by Court of Law of any country? *
40.2 Have you ever been refused entry / deported by any country including India? *
40.3 Have you ever been engaged in Human trafficking/ Drug trafficking/ Child abuse/ Crime against women/ Economic offense / Financial fraud? *
40.4 Have you ever been engaged in Cyber crime/ Terrorist activities/ Sabotage/ Espionage/ Genocide/ Political killing/ other act of violence? *
40.5 Have you ever by any means or medium, expressed views that justify or glorify terrorist violence or that may encourage others to terrorist acts or other serious criminal acts? *
40.6 Have you sought asylum (political or otherwise)in any country? *
I hereby declare that the information furnished above is correct to the best of my knowledge and belief. In case the information is found false at any stage, I am liable for legal action / deportation /blacklisting or any other action as deemed fit by the visa issuing country. If your response to any of items between 40.1 to 40.6 is YES, please give details here below
41. Print your complete name below. *
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