Madhya Pradesh Police  
      Form of Application to be filled in by Alien
      Desiring to extend stay in India 
        Note: If any of the particulars furnished below are found to be 
        incorrect or if any information is found to have been withheld, the 
        extension is liable to be cancelled at any time

            1.(a) Name in full (Surname in 
            capitals)_______________________________________
            2.(b) Father's Name_______________________________________
            3.Address in India
            (a) Permanent :_______________________________________
            (b) Present : _______________________________________ 
            4.Nationality_______________________________________
            5.Date and Place of birth_______________________________________
            6.Profession or Present 
            Occupation_______________________________________
            7.Number and Date of Visa for India and where 
            issued_______________________________________
            8.Number and Date of Passport and Date upto which it is 
            valid_______________________________________
            9.Purpose of visit to India_______________________________________
            10.Whether resident in India previously and if so for what 
            period_______________________________________
            11.Date of expiry of authorized period of residence in 
            India_______________________________________
            12.Period for which extension is 
            required_______________________________________
            13.Whether permission to extend stay in India has been granted / 
            refused and if so, when?_______________________________________
            14.Reasons for extension of stay. (The stay should be stated fully 
            in detail. Failure to do so may result in delay or refusal of 
            request) In case of Missionaries, the exact nature of work on which 
            engaged should be stated._______________________________________

            _______________________________________

            _______________________________________
            15.Names and addresses of persons in India who furnished financial 
            guarantee for the maintenance and repatriation on behalf of the 
            applicant when he/she entered India.
            _______________________________________



            Signature


            Date: