TRAVEL AGENCY SUBMISSION FORM Click here to download [
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GRANDLOTUS INDIA VISA CENTRE SDN BHD
TRAVEL AGENCY SUBMISSION FORM
MALAYSIAN PASSPORT ONLY (for 10 passports & above)
| NO. |
FULL NAME |
PASSPORT NO. |
EXPIRY DATE |
PREVIOUS VISA EXPIRY DATE |
LAST DEPARTED DATE FROM INDIA |
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*NOTE: "PREVIOUS VISA EXPIRY DATE" & 'LAST DEPARTED DATE FROM INDIA" COLUMNS ABOVE APPLICABLE FOR TRAVELLERS BEEN TO INDIA PREVIOUSLY.
*FOR TRAVEL AGENT'S USE:
Agent's Signature : *Agent's Company Stamp
1) NAME :
2) I.C. NO :
3) CONTACT NO :
4) RECEIPT COLECTED BY :
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*FOR GRANDLOTUS INDIA VISA CENTRE USE:
*RECEIVING OFFICER:
*TOKEN NUM : *GIVE STAMP:
*DATE :
*DATE :
*TIME : AM/PM
*TOTAL PPT:
*PER PPT : RM
* TOTAL = RM
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