FOR OFFICIAL USE ONLY

Visa No.____________________________

GRR No. ___________________________

PHOTO
EMBASSY OF TANZANIA – TOKYO
4.5 × 3.5 cm Officer _____________________________

VISA APPLICATION FORM

Date _______________________________

Type of visa requested:  Travel visa  Transit visa

1. Surname or Family Name __________________________________________________________

2. First Name (s) ___________________________________________________________________
3. Maiden Name ___________________________________________________________________
4. Date of Birth ________________________________________ Sex ________________________
5. Place of Birth _____________________ Country of Birth ________________________________
6. Nationality _____________________________________________________________________
7. Current Address _________________________________________________________________
Tel ______________________________ E-mail _______________________________________
8. Marital status:  Married  Single  Divorced  Widowed
9. Names, date and place of birth of minor children accompanying you
* In case a minor is traveling alone, please submit a parental authority.
______________________________________________________________________________
10. Profession / Occupation __________________________________________________________
Employer’s address ______________________________________________________________
11. Passport No. ______________________ Date Issued ___________________________________
Valid Until _______________________ Issued At _____________________________________
12. Date of Entry _____________________ Departure Date _________________________________
Duration of Stay ________________ Budget available for your stay U.S.$___________________
13. Contact address in Tanzania _______________________________________________________
_________________________________________ Tel __________________________________
14. Purpose of Visit
 Leisure, Holiday  Other Business  Various
 Visiting friends, relatives  Study  Diplomatic
 Mission  Transit  Official
 Meeting, Conference  Health Treatment  Same day visitor
15. Requested number of entries:  Single  Double  Multiple
16. In case of transit: Do you have an entry permit for the final country of destination?
 Yes  No Valid until:
17. I hereby declare that the information stated above is true and correct:

Signature of Applicant ___________________________ Date ____________________________