1. Full name : Mr./Ms 

2. Permanent address:  

3. Place of birth:

4. Date of birth: 

5. Nationality:

6. Nature of Passport: Diplomatic/ official/ Ordinary/ UN Laissez-Passer

7. Passport number:

8. Date of issue:

9. Place of issue:

10. Date of expire: 

11. Occupation/Profession:

12. Period for which visa is required: 

From:

To:

13. Point of entry / exit into Bhutan : 

Entry Point: ___________________________

Exit Point:   ___________________________

14.  Purpose for visiting Bhutan:

15. Is this your first visit to Bhutan ? Yes/ No.  If not give details of earlier

Visit:  

Place: 

Date:  

____________________________(Please delete whichever : is not applicable )
Signature of applicant

For official use only :

Type of visa__________________________________
Visa number__________________________________
Date of issue_________________________________ 

(Attach passport  size Photograph )

Visa clearance number_________________________