ĐẠI SỨ QUÁN EMBASSY

CỘNG HÒA XÃ HỘI CHỦ NGHĨA VIỆT NAM 0F THE SOCIALIST REPUBLIC OF VIETNAM
TẠI CỘNG HÒA Ả RẬP AI CẬP TO THE ARAB REPUBLIC OF EGYPT

APPLICATION FOR VISA Photo

4x6

(Please kindly fill this application in English language for our convenience)

1. Name in full: (Block letters):……………..…............................. …‫ الساــــم بالكامـــــل‬.

………………………………………………....................….....………………………
2. Date of birth: ..…........…/.…...........…/……......…..‫ تاريـــخ الميــــلدا‬........................
3. Sex:… ‫النــــــوع‬...................... M / F .

4. Place of birth:………………...................……………………‫ محـــــل الميـــــلدا‬...........

5. Nationality at birth:……….... ‫ الجنسية‬Present Nationality:…………..‫الجنسيــة الحالية‬

6. Passport: - Number……….........…….‫ رقم جواز السفر‬- Kind:…..........…‫نــوع الجـواز‬
- Date of issue:………..…‫تاريخ الصإدار‬... - Expiry Date:…........………‫تاريخ النتهاء‬
- Issued by:…………………………………………‫ مكان الصإدار‬................................
7. Profession:…………………………………………………‫ الوظيفــــــــة‬.......................
- Place of employment:……………………………………‫ مكــــان العمــــل‬....................
- Telephone:…………………‫ رقــــم الهاتـــف‬Email………………‫البريــد الليكترونــــي‬......
8. Present address: (home, street, city):……………………‫ العنـــــوان الحالــــــي‬..............
……………………………………………….........................………...
9.Accompanied children: (full name, DoB, relation)………‫الطأفــــال المرافقــــون‬............
………………………………………………….........................……………………….
10.Purpose of entry:…………………………….............……………‫سابـــب الزيــــارة‬.....
- Name, address of organization, relation, relatives to contact, visit in Vietnam :
…………………………………………………………………………………………..
11.Proposed date to entry-exit Viet Nam:………… ………...‫تاريــخ الوصإــول و المغـادارة‬
12.Have you been in Viet Nam?.....‫(هل زرت فيتنام ساابقا‬If yes),When?:……………‫متـــي؟‬
13.Number of entries:…....................……............................….‫عــــددا مـــــرات الـدخــــــول‬
14.Port of entry-exit: ………….…..………..............…‫ مينــــاء الوصإــــول – المغـــــادارة‬.....

I swear the above declarations are true for which I'll take responsibility.

Done in………..on…./…./……….

Signature
‫التوقـيـــــــــع‬