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Patient Details
Live Sync ActiveVISA UNDERTAKING FORM
I, SAMPLE FULL NAME, hereby undertake that, I shall utilise my visit only for the purpose of which, Visa has been applied. I also declare that I am residing in under the jurisdiction of High Commission of India, Dhaka on the date of making this application and that all the information given by me here is accurate, complete and true to my knowledge.
Personal Details
| Name (As per passport) | SAMPLE FULL NAME |
| Passport No | A00000000 |
| Nationality | Bangladeshi |
| Date of Birth | DD/MM/YYYY |
| Address in Dhaka | SAMPLE RESIDENTIAL ADDRESS, CITY, POSTCODE |
Purpose of Visit
I wish to visit India for the purpose of Medical Treatment (GENERAL MEDICINE) at SAMPLE HOSPITAL NAME
Return to Home Country
I undertake to return to my home country immediately upon the completion of my visit, and I confirm that I have no intention of overstaying my visa in India. I will return to Bangladesh.
Compliance with Indian Laws
I hereby pledge to fully comply with the laws, regulations, and customs of India during my stay. I acknowledge that I will not engage in any activity that is prohibited under Indian law and will respect the local customs and culture.
Acknowledgment and Declaration
I understand that any violation of Indian laws or regulations may lead to the cancellation of my visa and may affect my future eligibility for a visa to India.
I declare that all information provided in my visa application is accurate and truthful to the best of my knowledge. I understand that providing false or misleading information may result in the denial of my visa application.
I undertake to adhere to all the terms and conditions of my visa and will ensure that I leave India before the expiration of my authorized stay.