APPLICATION FORM BEFORE THE MINISTRY OF THE GOVERNMENT

For Organized, Agile and Safe Entry and Egress to Nicaragua

Of Visitors of Other Nationalities
Date ______ / _____ / ____
A) Applicant information:
1. * Surnames _______________________________ 2. * Names _______________________________________
3. * Sex: Female □ Male □; 4. place of birth ______________________________________________
5. * Birthdate _____________ / ___/ _____ 6. * Age _______ 7. * Nationality _____________________________
8. Other acquired nationality __________________________ 9. Profession or occupation ___________________
10. Workplace __________________________ 11. Work address _____________________________________
12. Email ______________________________ 13. * Phone _________________

8) * Type of travel document:

14. ID □ Safe conduct □ Passport □ ( * Type: Ordinary □ Official □ Service □ Special □ Other ________________)
* Country of Issue ____________________, * Document number ________________ * Issued ____ / ____ / _____
Expires ____/ _____/ ____
15. * Do you have a valid residence and/or visa? Yes □ No □ Both □ (if yes, please complete the following information)
* Country of residence ___________________, * Residence number ______________, * Issued ____ / ____ / _____
* Expires _ / _____ / ____
* Visas: USA □ Schengen □ Canadian □ Other: ___________________________, * Issued ______/ _____ / _____
* Expires _ / _____ / ____

C) Trip details:
16. * Select entry type: One entry □ Multiple entry □ Transit □ Transit and return □
17. * Entry date _______ / ___ / ___ * * Border Post ________________________ * country of origin __________
18. * Departure date _/ ______ / ___ * * Border Post ______________________ * destination country __________
19. * Conveyance: Transferring □ Own vehicle □ Other ____________________
20. Brand ___________________, 21. Model ____________________, 22. Plate ____________________
23. * Reason:□ Tourism □ Sport □ Medical □ Study □ Other _____________________
□ Work □ Religious □ Family □ Residency procedure
* Specify reason _____________________________________________________________________________

24. * Planned address in Nicaragua _____________________________________________________________

25. * ** Companions: Yes □ No □ 26. Number of people _______ 27. Relationship ________________________

D) * If you were invited, fill out the following information □ Yes □ No

28. * Through: □ Assoc. /Fund. /Org. /NGO □ Family/Friendship □ Company □ Academic

□ Other ___________________________
29. * Name of the person, company or organization _________________________________________________
30. * Company or organization representative _____________________________________________________
31. * Identification No. ______________, 32. * Nationality ______________________, Bond _________________
33. * Telephone number _______, 34. * Address in Nicaragua _________________________________________

* Signature and seal of the applicant.

Grades:
*Required fields. - ** On the next page you will find a chart of the border posts and if you are traveling with companions, you must fill out the list.
1. The request must be sent in advance of your arrival in the country and sent to the email reservas@migob.gob.ni ;

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2. Visitors who have an invitation from organizations or associations must be sent by the organization in Nicaragua.
3. Entry requirement to Nicaragua related to the international certificate of vaccination against yellow fever, according to PAHO countries.
 Information about companions traveling with the applicant
Document number Country of Dates Border Posts
Surnames Names Date of birth. Identification Due date Nationality
Passport Issue Entrance Exit Entrance Exit
card

Note: Fill out each of the requested fields and attach a copy of the applicants' travel documents ( identity card, safe-conduct and passport ).

Recommendations:

Attach supporting documentation for the requests as appropriate:

✓ Relatives. ( marriage or birth certificates (children) )

✓ Medical. ( epicrisis, recipe books or appointment control cards ) Terrestrial

✓ Academics ( proof of active student, student card or payment receipt )

Maritime
✓ Labor ( employment certificate or invitation )
✓ Hotels and/or hostels in Nicaragua ( submit reservation )

Ministry of the Interior.

Nicaragua Republic.