Data Sheet for Repatriation to West Bengal

High Commission of India, Dhaka, Bangladesh  

Repatriation by Land Border

Please read the following instructions carefully before filling-up the registration form:
  • Please fill-up all the details correctly without any mistake.
  • Give correct contact numbers and email address for all future communications and information related to your repatriation.
  • If details of family members (name, passport no, etc) are not added, only one person will be considered for return to India.
  • Students have to register individually.
  • For further queries contact
* Required
Name ( as per passport )*
Surname ( as per passport )*
 Male  Female
Age (in Years) *
Passport No*
Email Address*
Land Border *
Reason for travelling back to India *
Visa Type *
Are you staying with Family (Yes/No) *
Current Address in Bangladesh*
District in Bangladesh*
Contact No (In Bangladesh)*
Contact No (In India)*
District in West Bengal*
Full Address in West Bengal*


High Commission of India

Dhaka, Bangladesh

Sub: Consent Form for Repatriation from Dhaka , Bangladesh

  1. I hereby confirm my willingness to return to India in accordance with the terms of the High Commission
  2. I confirm my readiness to follow all instructions given by the officials of the Government of India / High Commission of India / Local authorities/ medical personnel on arrival.
  3. I agree to undergo a minimum 7 days mandatory quarantine (quarantine period may be more if decided by local authority) on my arrival in India at my own expense as per the protocols framed by the Government of India.
  4. I am willing to bear the cost of traveling back to India.

  I agree with the above undertaking