M3

EON XIN NHAP XUAT CANH VIET NAM

(Dung cho ngudi nu6c ngodi)
APPLICATION FOR ENTRY AND EXIT VISA
(Forforeigners)
Photo
I - Ho t€n (chtr in hoa) ........... 4x6cm
I\lante and surname (in block letters)

2- Ngdy sinh:.......... 3- Gi6i tfnh: ................

Date of birth Sex

4- Noi sinh: .......... 10- Muc dich xu6t nhdp cinh:

Place of birth Purpose ofentry and exit

5- Qu6c tich g6c: TCn, dia chi co quan, t6 chri'c ho[c ho tdn, quan h6 dia
chi cta thAn nhdn - noi ldm vi6c hodc thdm
Nationality at birth Name, address of ffice, organization or full name,
relation, address of your relatives to contact or visit
Qudc tich hi€n tai
Present nationality

I 1- Thdi gian du ki6n NXC Vi6t Nam:

sti:
6- Hg chitiu .......
.......Loai: " Ti'ngiy d6n ngiy:
Passport No Kind of passport propossed duration to entry aici exit Vietnam
From to
- Ngdy c6p.........................Gi6 tri d6n ....., 12- crtakhau XNC vi6t Nam:
' Port of awival and departure
Date oJ'issue Valid up to
- Lo'quan cap: ........... l3- Tdi cam doan nhfing n6i dung tr0n diy li dring su
that.
Issued by I iwear the above declarations are true for which.
7- Nghe nghi6p:...... I shall take responsibility

Profession
No'i lhm viQc:.......... Lim tai ..ngay
Done at on
Place of employment K1i t6n
8- Dia chi cu tni hi6n nay: ........... Signature

Present address
9- Tre em di ctng (ho tdn, ngdy sinh, quan hd):
Children accompanying (full name, date of birth,
relation)

Note: - Please, in two forms (attaching two latest photos, in 4 x 6 cm size, with aface straight
fill
forward) submit oneform to the Vietnam visa issuing ffice, or consulate, and the other to
frontier, police post upon your arrival
- The accompanying children under 11 years old may be included in this form, with two photos.