EMBASSY OF INDIA
HAVANA
REGISTRATION FORM FOR INDIAN NATIONALS
1 PERSONAL PARTICULARS
i) Name
ii) Father’s name
iii) Spouse name
iv) Date & place of Birth
v) Date of arrival in the country
2 PASSPORT DETAILS
i) Passport Number
ii) Date of issue
iii) Place of issue
iv) Date of expiry
3 CONTACT DETAILS
i) Residential address
ii) Telephone No. residence
iii) Mobile number
iv) Email address
4 EMPLOYMENT DETAILS
i) Name of the Company/Firm
ii) Office address
iii) Contact details
iv) Date of joining of Company/Firm
5 PERMANENT ADDRESS IN INDIA
6 DOCUMENTS TO BE ATTACHED
i) Passport copy
ii) Copy of office/local Identity card (if any)
Place :
Date :
(Signature of the applicant)