-

/GEORGIA

/VISA APPLICATION

PHOTO

1. / Last name

/ First name

2. / Other names
4. / Date of birth

3.

Sex
Male
Female
/ Place of birth

1.

6. / Passport number

/ Citizenship

( )
(in case of dual citizenship please indicate both)

8.
Permanent address
9. / Employer

7. / Type of passport
) / Diplomatic
) / Service
) / Ordinary
) /Travel Document

/ Position

10. , / Spouse children under 18 years of age

/
/
/
/
/
Last Name First Name
Date of Birth
Citizenship
Relationship to applicant

11. , , .: / Name, address and

telephone of the inviting organization or person

12. / Your address during your stay in Georgia

13. ?/ Have you ever been

convicted of criminal offence in any country?
/ Yes
/No
16. /
14. /Purpose of your
Length of intended stay in Georgia
visit to Georgia
)
)
)
Day(s)
month(s)
year(s)
)
)
)
17. /Date of entry
Official
Business
Private
)
)
18. / Date of departure
Tourism
Other
15. / Passport valid until

19. - /
Number of entries

)
one

)
two

)
multiple

,
I declare that the information provided in this application form is correct

Date

Personal signature