Enter Full Name
Permanent Address
Place of Birth
Date of Birth	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Nationality
Nature of Passport	Diplomatic Ordinary Official UN Laissez-Passer
Passport Number
Date of Issue	-- dd/mm/yy
Place of Issue
Date of Expiry	-- dd/mm/yy
Occupation/Profession
Period for which Visa is required	From    -- dd/mm/yy	To    -- dd/mm/yy
Point of entry/exit	ENTRY POINT Bangkok Kathmandu Kolkata Delhi Via Phuentsholing	EXIT POINT Paro Airport Phuentsholing
Purpose of visit to Bhutan	SELECT PURPOSE Holiday Business Official Diplomatic
Is this your first visit to Bhutan	Yes No
If not please give details of earlier visit		Date -- dd/mm/yy