Consulate General of Pakistan Chicago 333 N Michigan Ave, Suite 728, Chicago IL 60601 Tel: 312-781-1831 Ext 2008 fax: 312-781-1839 info@cgpkchicago.org (Please read these instructions carefully before filling in the application form) 1. No column should be left blank. Incomplete forms with vague entries will not Photograph must be: be accepted. Where applicable copies of supportive documents should be submitted along with the application form.  Passport size 2x2 2. Applicants may use extra sheets, in case of in sufficient space in the form.  Recent and true 3. Applicants may be asked to appear for an interview if required. likeness, showing full face, with no hat, 4. On arrival, immigration formalities are mandatory. (police registration is helmet or sunglasses. applicable in certain cases) Although reading/sight 5. Attach bank statement for business visit. glasses may be worn. 6. Applicants family” includes spouse, son, daughter, father, and mother. 7. Use BLACK INK ONLY and write in BLOCK CAPITAL ONLY PART – 1 1. Type of Visa Applied for: Diplomatic  Official  Family  Transit  Military  Journalist  Business  Tourist  Others  Please Specify: __________ 2. Purpose of Visit: 3. Duration of Stay: 4. Visa required for: Less than 01 Month 06 Months 1Year 2Years 5Years 5. Type of Visa Single  Double Multiple i. Port of Entry_______________ ii. Port of Departure_______________ iii. Places to be visited in Pakistan a_____________b_____________c______________d______________ 6. Section I (Applicants Details) i. Name as in Passport: __________________________________________________________ First ii: Date of Birth Middle Last ___________________ dd / mm / yyyy iii: Place of Birth: City:___________________ Country:____________________ iv: Sex: Male  Female  v. vi: Marital Status: Single Married  vii: Identification Mark: _________________________ viii: ix: Nationality: a.Present ___________b.Previous__________ c.Dual___________ x. Religion: ___________________ xi: PASSPORT DETAILS: Type of Passport: Native Language:________ Diplomatic  Official / Service  Ordinary  UN Travel Document Passport Number___________Place of Issue___________ Date of issue ___________ Date of Expiry___________ Issuing Authority__________________________________ -1- xii: ADDRESS & EMAIL a. In USA _______________________________________________________ City________________State____________Zip_________________ b. Telephone: Home _____________ Work _____________ Cell _____________ In Pakistan _______________________________________________________ _______________________________________________________ xiii: Telephone: Home _____________ Work _____________ Cell _____________ Email: _______________________________________________________ Is your Visit Sponsored? Name of Sponsor _____________ _____________ Yes  (if Yes please give details) Address __________________ __________________ __________________ No  Contact Number Home _____________ Work _____________ Cell _____________ b: Sponsor’s Details (In Pakistan / USA – If applicable). Name Address Telephone Email: Cell: Work: Home: xiv: Details of Profession: (Please specify Rank/Service in case of Armed Forces / Uniform Personnel) a: ___________________________________________________________________________ Note: In case of Military Services, please fill in the attached Performa. xv: Details of Jobs held in the past: a. Designation _____________ b. Department _____________ c. Duration(from-to)_____________ d. Duties _____________ e. Address & Phone No. _________________________________________________ _________________________________________________ f. Name, address and contact details of immediate Head/any other colleague: Use extra sheet if required ____________________________________________________________________ ____________________________________________________________________ xvi: Are you applying for a visa from a third country? Yes  No  If yes, please provide a copy of Residence / Work permit of that Country 7. i. iii. v. SECTION II (FAMILY DETAILS) Name of Mother ___________________ ii. Mother’s Nationality ___________________ Name of Father ___________________ iv. Father’s Nationality ___________________ Spouse Details: Name___________________ Nationality ___________________ Date & Place of Birth___________________ Profession___________________ Name, address & contact details of employer of spouse (if any) ____________________________________________________________________ ____________________________________________________________________ -2- vi. Do you have any children? Yes  (If yes please provide details of each child) Name (First, Middle, Last) vii. No  Date of Birth (mm/dd/yyyy) Please list any of accompanying person / family member (including children) traveling with you to Pakistan. Full Name Date of Birth Passport Number Address viii. Do you have any Bank Accounts in Pakistan? Yes  (If yes please provide details) No  Bank Name Branch A/C Number Address Verifier Details 8. i. TRAVEL HISTORY: Have you ever visited Pakistan during the last five years? Yes  (If yes please provide details) No  Date Destination / Address Purpose Duration Purpose Duration 1. 2. 3. 4. 5. ii. Details of other Countries visited during the last 2 years Date Destination / Address 1. 2. 3. 4. 5. iii. Have you ever been refused a visa for any country including Pakistan? Yes  No  -3- iv. Have you ever been refused entry on arrival to Pakistan? Yes  (If yes please provide details of refusal) No  v. Have you ever been deported, removed or otherwise required to leave any country, including Pakistan? Yes  (If yes please provide details) No  Date Country Reason Reference Number (For Pakistan) vi. Do you have any criminal convictions or charged in any country? Yes  (If yes please provide details) No  Date Country Offence Sentence DECLARATION: I declare that the information given in this form is correct to the best of my knowledge and belief and if any of the particulars furnished above are found to be incorrect or withheld the visa is liable to be rejected / cancelled at any time. Date ___________________ Signature of the Applicant ____________________________ -4-