Application for entry visa to Israel
Instructions for completing application form:
1. Please attach a recent photograph 5.5 x 5.5 cm.
2. If application is not for the purpose of visit, spcify
    reason and supply documentation.
3. Please fill in following details in English:
photograph 5.5 x 5.5 cm
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Previous family name Mother's name Father's name Given name (as per passport) Surname (as per passport)

Previous nationality Present nationality Occupation Date of birth Place of birth


Type Of Travel Docs Family Status Gender
Valid untill Issued on Issued at Number
Married Single
Widow Divorced

If you hold a Laissez-Passer issued by the State of your permanent residence, state whether you have a return visa and indicate its validity
      Purpose of entry into Israel

Permanent address in India / Your country of residence
Personal Mobile no. Alternate Mobile no. Personal Email Id Permanent Address City Country

Countries of transit as per your flight ticket Requested duration of stay in Israel Anticipated date place of entry to Israel Address of staying in Israel

Category of residence permit (visitor, temporary resident, resident, immigrant, work) Dates of previous stays in Israel
1. 2. 3.

Particulars of dependants spouse/children of the Applicant

Spouse (Note:Not applicable for single)

Date of birth Place of birth Father's name Maiden name Given name
Family name Travelling with Passport

Children under the age of 18

Travelling with Passport Date of birth Place of birth Given name  

Children above the age of 18

Travelling with Passport Date of birth Place of birth Given name  

Family Member/Relative/Friends in Israel

Telephone No Email Address Relationship Name  

Details of The Agency

Agency Name Mobile Landline No Email  
.1
License No: Type of Agency: Agency Address:

Upload File/attachment

Id Proof
Upload attachment as per your Visa application

Declaration

I declare that the particulars contained in this application are correct and have been made in awareness of the fact that they are to serve as basis for the consideration of my application. I also declare that I have not committed any criminal offence or any act directed against the Jewish people or the security of the state of Israel and that I am not affected with any illness which might endanger public health. There is no judicial warrant against me and I am not wanted by the police of any country. I hereby declare that I have not been issued with a restraining order. Furthermore, I have not been denied entry into Israel. I am aware that if a preventive order of this kind has been issued against me, I will be denied entry into Israel, and will be sent back to my country of origin. I am also aware that the receipt of a visa does not in any way invalidate the right of the Israel Ministry of the Interior to deny my entry into the territory of the State of Israel, if it becomes clear that the visa was issued on the basis of false information.



Applicant's Name Date Place