Personal DataFamily name *Photo *Choose FileNo file chosenDelete uploaded fileThe photograph to be uploaded should be in color and of the size of 2 inch x 2 inch (51mmx51mm). The photo-print should be clear and with a continuous-tone quality. It should have full face, front-view, eyes open and should present full head from top of hair to bottom of chin.First name *Date of birth *Place (including your country) of birth *Religion *Sex *Nationality *Other NationalityCountry of birthMarital Status *SelectSingleMarriedDivorcedWidowedProfession *Mobile Number *Email AddressCurrent Address *Permanent address (if different from current address)Level of education *SelectIlliteratePrimarySecondaryUniversityVocationalNational Identity Number *Information about the passportType of PassportSelectOrdinaryServiceDiplomaticOther to be specifiedOther to be specifiedPassport Number *Date of Issue *Date of Expiry *Place of Issue *If married, name of spouse *Spouse's Contact Number *Spouse's Email Address *Number of children *Father's Name *Mother's Name *Reason for Trip *SelectTourismOfficial VisitBusinessStudiesMedical ReasonsVisit to Family or FriendsCultureSportArtTransitOtherOther reason for trip *Have you visited Chad before? *YesNoReason *Place of residence *Telephone Number *Information about visa requestedValidity of visa sought *Number of entries *Expected date of arrival in Chad *Expected date of departure from Chad *Previous Chadian Visa InformationDurationYear ObtainedType of VisaInformation about your stay in ChadName of hotelTelephone NumberEmail AddressList of countries visited in the last five yearsCountry *Year *Reason of visiting *Professional InformationName of employer *Position held *Supervisor's Name *Contact Details *Medical InformationDo you suffer from a contagious disease? *YesNoIf yes, which one? *Have you suffered from a mental health problem that has caused you to be a threat to yourself or others, or to be hospitalized? *YesNoInformation on crime and safetyHave you ever been arrested or convicted of a criminal offence? *YesNoIf yes, please give details *Have you ever witnessed or participated in the mistreatment of prisoners or civilians, or the looting or desecration of religious buildings? *YesNoMandatory documents to be attached as a hard copy with submiited form An invitation from Chad with copy of passport of the person inviting (send to the Embassy via the address of the person inviting) or hotel reservation ; A copy of passport valid for at least 6 months ; A copy of a vaccination card. Proof of payment of the non-refundable visa fees of INR 20,000 (to be deposited in the Embassy's account with the HDFC bank: 50200088921299 Optional documents to be attached as a hard copy with submiited form Copies of previous visas ; An application mentioning the name of the company (mandatory for business visa applications) ; I am informed that the visa fee is non-refundable if the visa is refused: yes. My signature engages my responsibility and exposes me, in addition to the proceedings provided for by the laws in force in the event of false declaration, to be refused any visa for entry to Chad in the future.NoteThis form must be fully completed online, downloaded and signed by the person applying for the visa, enclosing the required documents, and sent to the Chadian Embassy at the address above. If the applicant is a minor (under 18), the form must be signed by the person with parental authority (father and/or mother, guardian), specifying in brackets the relationship between the two persons.Place *Date *Signature *Submit
