01 Photo

(2 inches x 2 inches)
APPLICATION FORM Glued photo here

FOR ENTRY AND EXIT VISA and

01 additional photo
CONSULATE GENERAL OF VIETNAM stapled to this form for a
loose -leaf visa request
IN SAN FRANCISCO, US
1700 California Street, Suite 580
San Francisco, CA 94109
Tel: 415 922 1707; 415 922 8588
www.vietnamconsulate-sf.org

1. Full name (in BLOCK letters): ..................................................................................................................................................................

Family name First name Middle name

Date of birth: .............. /......................./........................ Gender: Male Female

Date Month Year

2. Place of birth:…...............................………………………... 8. Name, address of your contact (organization or

3. Nationality at birth: ..................................….........………
Nationality at present: ...........…………………...…......
4. Passport number: ......................................……........…...…
individual) in Vietnam (if any):
.............................................................................................................................
.............................................................................................................................
..............................................................................................................................

Date of expiry:............................………………………....... 9. Proposed DATE OF ENTRY into and EXIT from

5. Employer: ................................................................................ Vietnam:

6. Mailing address: ...............................................….……..... -From: .................. /................... /.....................

Date Month Year
..........................………………………...........................…..…..….

Contact number: .........................……………................... -To: ............. /.................... / ......................

Date Month Year
7. Purpose of visit to Vietnam:
10. Requesting a visa good for:
Business Tourist Visit Relatives
-Number of entries: Single Multiple
or other: ................................................................................
________________________________________ -Total length of stay: 01Month 03Months
Please submit the following documents:
06 Months One-Year (U.S passport only)
One copy of application form with one passport photo
Original passport (for visa sticker) or Copy of passport
(for loose-leaf visa) I solemnly declare that the statements made in this
Visa fee (please call Visa section: 415-922-8588; 415- 922- application are true and correct.
1707 Ext 101 / 102 / 108/ 118 for current fees)
If apply by mail, pls. enclose a prepaid self-addressed Signature:
return envelope and retain one copy of the application
form for enquiry about visa status

* Visa will be valid from the DATE OF ENTRY (shown on the visa). You can enter Viet Nam on or after the DATE OF ENTRY and must leave before the
end of expiration date.
* The Vietnam Customs and Border Protection at the port of entry determines the period of each authorized stay for travelers with one-year visas.
* Please double check all information on visa issued by the Consulate. In case of mistake(s), please contact the Consulate immediately for correction,
Phone number: 415-922-8588; 415-922-1707 Ext 101/102/108/118 (office hours) or Hotline 415-533-0156.