01

Place

Siddhaloka,

Bachenahatti Post, Magadi Taluk,

Bangalore Rural District

02

Name of the Foreign Visitor

(in full block capitals, surname first)

03

Nationality

04

Number, Date and place of issue of Passport

05

Address in India (other than Tourist)

06

Date of arrival in India

07

Date of arrival at Siddhaloka

08

Arrival From

09

Whether employed in India (yes/no)

10

Proposed duration of stay in India

11

Proposed duration of stay at Siddhaloka

12

Number, date and office of issue of  Certificate of Registration if any

13

Address to which proceeding.