CHINA EMBASSY VISA APPLICATION

Note: Please fill up the details especially the red mark (*)

>*NAME
*Family Name (as shown on your passport or travel document)

___________________________________________________

*Given Name(s) (as shown on your passport or travel document)

___________________________________________________

Other Name(s) or Former name(s)

___________________________________________________

Chinese Name (if applicable, in Chinese)

___________________________________________________

>*Date of Birth
*Year: ___________ *Month: ____________ *Day: ____________

>*Gender (Use Check)

Female Male

>*Place of Birth
*Country or Region: ________________________

*Province/State: _______________________

*City: __________________________
STA MARIA

>*Marital Status (Use Check)

Married Single Divorced Widowed Other (Please specify): __________________

>*Nationality and permanent residence

*Nationality: _________________________

*National ID number (If Applicable): _________________________________

*Do you hold any other nationality? Yes No

(If you check (Yes), please fill up the details below and If (No), check only)

*Other Nationality: ____________________________

ID number of other nationality: ________________________________

Passport number of other nationality: _____________________________

Please specify the reason why neither (ID number of the nationality) nor (Passport number of
other nationality) is provided.

____________________________________________________________________________________
*Do you have permanent residence of any other country or region? Yes No

(If you check (Yes), please fill up the details below and if (No), check only)

*Other permanent resident countries or region

_______________________________________

*Have you ever held any other nationality? Yes No

(If you check (Yes), please fill up the details below and if (No), check only)

*Former nationality

_______________________________________

>*Passport
*Type of passport/travel document (Use Check)

Diplomatic Service Official Special Ordinary Other (Please specify): _________________

*Passport/travel document number: ___________________________

*Issuing country or region: ____________________________

*Place of issue: _____________________________

*Expiration Date: (Year: _____________ Month: ______________ Day: _______________)

(Please ensure that your passport is valid for no less than 6 months.)

>*Type of Visa and Major purpose of your visit to China

*Type of Visa and Major purpose of your visit to China:

_____________________________________________

>*Service (Use Check)

Normal Express

>*Application details

*Entries (Use Check) Single Double Multiple

*Maximum duration of longest stay (days) (Based in the itinerary): _________________

*Validity of Visa (months): ________________

 >*Occupation (Use Check)

Businessperson Company employee Entertainer Industrial/Agricultural worker

Student Member of parliament Government Official NGO Staff Military Personnel

Religious Personnel Media Representative Crew Member Self-Employed Unemployed

Retired Academic Other (Please specify) _________________________________

>Work experience in the last five years

*Employment date from: (Year: ________________ Month: __________________)

*Employment date to: (Year: _________________ Month: __________________)

*Name of your employer: ____________________________________________

*Address of your employer: __________________________________________

*Telephone number of your employer or Phone number: ________________________________

Position: ___________________

Duty: __________________

*Supervisor’s Name: ______________________________

*Supervisor’s telephone number or Phone number: _________________________

>Highest level of education

*Name of School: _____________________________________________________

*Diploma/Degree (Use Check):

Graduate or other equivalent study.

Undergraduate or other equivalent study.

PHD or above.

High school or other equivalent study.

Major: ______________________________________________________________
 >*Current residence address

*Current residence address:

_____________________________________________________________________________________

*Phone number: (Country code: _______________, Phone number: __________________)

*Mobile phone number: _____________________________

E-mail address: _____________________________

>*Spouse

*Family Name: __________________________

*Given Name: __________________________

*Nationality: __________________________

Current Occupation (Use Check):

Businessperson Company employee Entertainer Industrial/Agricultural worker

Student Member of parliament Government Official NGO Staff Military Personnel

Religious Personnel Media Representative Crew Member Self-Employed Unemployed

Retired Academic Other (Please specify) _________________________________

*Date of Birth: (*Year: _____________, *Month: ________________, *Day: _______________)

*Country of Birth: _____________________

*City of Birth: _______________________

*Address: _________________________

>*Father
*Family Name: _________________________

*Given Name: _________________________

*Nationality: _________________________

*Date of Birth: (*Year: _____________, *Month: ________________, *Day: _______________)

*Is your father in China (Use Check): Yes No

 >*Mother
*Family Name: _________________________

*Given Name: _________________________

*Nationality: _________________________

*Date of Birth: (*Year: _____________, *Month: ________________, *Day: _______________)

*Is your mother in China (Use Check): Yes No

>*CHILD Not Applicable

*Family Name: _________________________

*Given Name: _________________________

*Nationality: _________________________

*Date of Birth: (*Year: _____________, *Month: ________________, *Day: _______________)

>Do you have any immediate relatives, not including parents, in China? Yes No

>Information about Your Intended Trip

*Intended date of arrival: (*Year: ______________, *Month: _______________, *Day: _____________)

Arrival Train/Ship/Flight number: ___________________________

*City Arrival: (*City: ____________________)

(Districts/countries (Leave empty if not applicable): ______________________)

>Itinerary
*City Arrival: (*City: ____________________)

(Districts/countries (Leave empty if not applicable): ______________________)

Address: _____________________________________________________________________________

*Date of Arrival: (*Year: ______________, *Month: _______________, *Day: _____________)

*Date of Departure: (*Year: ______________, *Month: _______________, *Day: _____________)

>Information About Your Intended Trip

*Intended date of arrival: (*Year: ______________, *Month: _______________, *Day: _____________)

Departure Train/Ship/Flight number: ___________________________

*City Departure: (*City: ____________________)

(Districts/countries (Leave empty if not applicable): ______________________)

 > Inviting person or organization in China (Not Applicable)

Name of person or organization: __________________________________________________________

Relationship to you (If invited by an individual) (Not Applicable)

Phone number: (Country code: _______________, Phone number: __________________)

E-mail address: ________________________________________________________

Address: (Province/State: _______________, City: ________________, Post code: ______________)

>*Emergency Contact

*Family Name: _______________________

*Given Name: _______________________

*Relationship to you: ___________________

*Phone number: (Country code: _______________, Phone number: __________________)

E-mail Address: _________________________________

>*Who will pay for this travel (Use Check)

Self (If you choose (Self), check only)

Other (If you choose (Other), Answer the following details below)

*Name: ___________________________________________

*Phone number: (Country code: _______________, Phone number: __________________)

E-mail address: _____________________________________________

Organization (If you choose (Organization), Answer the following details below)

*Name: _____________________________________________

*Relationship to you: __________________________________

*Address: ___________________________________________

*Country: ___________________________________________
 >Accompanying Person(s) (Use Check)

*Do you have accompanying person(s) (meaning person(s) using the same passport as yours)

Yes (If you choose (Yes), Answer the questions below) No (If you choose (No), check only)

*Family Name: ________________________________

*Given Name: _______________________________

*Gender: ________________

*Date of Birth: (*Year: _____________, *Month: ________________, *Day: _______________)

*Note please send photo your accompanying person(s) to attach in your application.

>Have you ever been to China? Yes No

>Previous Chinese Visa

*Have you been issued a Chinese visa? Yes No

(If you choose (Yes), Please give the details below of your last Chinese Visa) (If you choose (No), Check
only)

*Type of Visa: _______________ *Visa Number: _________________

*Place of Issue: ___________________

*Issue date: (*Year: _____________, *Month: _____________,)

*Have you ever been fingerprinted when applying for a Chinese Visa? Yes No

(If you choose (Yes), Please give the details below of where you fingerprinted) (If you choose (No), Check
only)

*Country or Region: ___________________ *City: _______________________

*When you were fingerprinted? (*Year: _____________, *Month: _____________, *Day: ___________)

*Have you ever been issued a Chinese residence permit? Yes No

(If you choose (Yes), Please give the details below) (If you choose (No), Check only)

*Residence permit number: ______________________________

 >Valid Visas
*Do you currently hold any valid visa issued by other countries? Yes No

(If you choose (Yes), Please list below) (If you choose (No), Check only)

_____________________________________________________________________________________

>Countries visited in the last 12 months

*Have you visited other countries or region in the last 12 months? Yes No

(If you choose (Yes), Please list below) (If you choose (No), Check only)

_____________________________________________________________________________________

*Have your ever been refused a visa for China, or been refused entry into China? Yes No

*Has your Chinese visa ever been cancelled? Yes No

*Have you ever entered China illegally, overstayed, or worked illegally? Yes No

*Do you have any criminal record in China or any other country? Yes No

*Do you have any serious mental disorder or infectious disease? Yes No

*Have you ever visited countries or territories where there is an epidemic in the last 30 days? Yes No

*Have you ever been trained or do you have any special skills in the field of firearms, explosives, nuclear
devices, biological or chemical products? Yes No

*Are you serving or have you ever served in the military? Yes No

*Have you served or participated in any paramilitary organization, civil armed units, guerrilla forces or
armed organizations, or been its member? Yes No

*Do you work for any professional, social or charitable organization? Yes No

*Is there anything else you want to declare? Yes No

*Has this application been completed by anyone else on your behalf? Yes No