GOVERNMENT OF INDIA
DISEMBARKATION CARD
(Please use capital letters only)

1. Name:Mr/Ms/Mrs.(名前)　　　　　TARO
Surname（姓）　　　　　　　　　　　 　SUZUKI
Other Name
2. Date of Birth(D/M/Y)：生年月日　　 　1 OCT.1900
Place and Country of Birth：出生地　 TOKYO
3. Nationality　　　　　　　　　　　　 　JAPANESE
4. Occupation　　　　　　　　　　　　 　COMPANY　EMPLOYEE
5. Passport No.　　　　　　　　　　　 　XX1234567
Place of issue TOKYO
Date of issue(D/M/Y) 　 10 AUG 1995
6.(To be filled in by foreigners only)
Visa No. 12345
Date of issue 9 FEB 1998
Place of issue TOKYO
Valid upto 8 FEB 1999
7. Address of India 　 QUALITY INN ARUNA
8. Port of Embarkation SINGAPORE
Flight No. SQ 410
9. Purpose of visit BUSINESS
10. No

CUSTOMS

1. Name in Full TARO SUZUKI
2. Flight No. SQ 410
3. No. of Packages
(a)Checked Baggage １
(b)Hand Baggage １
4. Total value of dutiable goods being imported: NONE

Signature of Passengerサインを漢字で

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