Professional Documents
Culture Documents
Application Form
Application Form
Photo
3x4 cm
APPLICATION FOR VISA OR TRANSIT VISA
N XIN CP TH THC NHP CNH HOC QU CNH
[Section 7(1)(g) read with section 10A and 10B; Regulation 8(1)]
Failure to complete this application form in full may result in the visa being delayed or refused.
Please use block letters and black ink only.
Nu khng in y vo mu n, thi gian xt n ca bn s c th b ko di hoc b t chi.
Ch s dng mc en v ch in hoa.
PLEASE COMPLETE THIS FORM IN ENGLISH. ngh khai n bng ting Anh
Date of birth:
(Ngy sinh)
Country of birth:
Ni sinh (quc gia)
Gender:
Gii tnh
Male
Nam
Female
N
Nationality: ...................................
Quc tch:
C quan cp:
Ngy ht hn
Occupation or profession: ..
Ngh nghip
Name, address and telephone no. of employer, university, organisation, etc. to which you are attached, or that you attend or which you
represent Tn, a ch v s in thoi ca c quan tuyn dng, trng i hc, t chc, vv.. m bn i din
...
...
...
...
If self-employed, state name, address, telephone no. and nature of business Nu lm vic t do, ngh khai tn, a ch, s in thoi v c
th cng vic ca bn
...
...
...
................................................................................................................................................................................................................................................
Marital status:
Tnh trng hn
nhn
Never
married
Cha kt
hn
Widowed
mt
Married
kt hn
Separated
Ly thn
Divorced
Ly d
Date of birth:
Ngy sinh
(Nm, thng, ngy)
Nationality....................
Quc tch
NB: SEPARATE FORMS MUST BE COMPLETED IN RESPECT OF PERSONS OVER THE AGE OF 16 AND CHILDREN UNDER THE AGE OF
16 TRAVELLING ON THEIR OWN PASSPORTS.
Lu : ngi trn 16 tui v tr em di 16 tui i bng h chiu ring phi in vo mu n xin th thc ring
First name(s) Tn
(1)
(2)
(3)
(4)
Date of birth
Ngy sinh
Place of birth
Ni sinh
Names of organisations or persons you will be contacting during your stay in the Republic:
Tn t chc hoc ngi bn s lin lc trong thi gian bn Nam phi
Name Tn
Address - a ch
Relationship
Mi quan h
Identity document number or permanent residence permit number of South African host:
S chng minh nhn dn hoc s giy php c tr di hn ca ngi mi bn Nam phi
.......
Indicate by means of an X whichever is applicable - nh du X vo ch thch hp
Have you at any time applied for a permit to settle permanently in South Africa?
Bn bao gi xin nh c di hn Nam phi cha?
Yes
C
No
Khng
Have you ever been restricted or refused entry into South Africa?
Bn bao gi b hn ch hoc b t chi vo Nam phi cha?
Yes
C
No
Khng
Have you ever been deported from or ordered to leave South Africa?
Bn bao gi b trc xut hoc bt buc phi ri Nam phi cha?
Yes
C
No
Khng
Yes
C
No
Khng
Yes
C
No
Khng
Yes
C
No
Khng
Are you suffering from tuberculosis or any other infectious or contagious disease or any mental or
physical deficiency?
Bn c mc bn lao phi, bnh truyn nhim hoc bnh v thn kinh hoc th cht khng?
Yes
C
No
Khng
Yes
C
No
Khng
Are you a member of, or adherent to an association or organisation advocating the practice of social
Yes
C
No
Khng
violence or racial hatred or are you or have you been a member of an organisation or association utilizing
crime or terrorism to pursue its ends?
Bn c phi l thnh vin hoc c tham gia vo t chc hoc hi c s dng bo lc x hi hoc phn bit chng
tc hoc bn tng l thnh vin hoc c tham gia vo t chc hoc hi s dng hnh ng phm ti hoc khng
b theo ui mc ch ca mnh khng?
Give particulars if reply to one or more of the questions above is in the affirmative:
Nu c cu tr li c, ngh nu chi tit:
...
..
...
To be completed only by passengers in transit to another country Nu qu cnh Nam phi I n nc khc
Destination after leaving the Republic: ...
Quc gia n sau khi qu cnh Nam phi
Mode of travel to destination: ....
Phng tin i
Intended date and port of departure from the Republic to that destination:
Ngy v ca khu d kin ri Nam phi n quc gia
Do you hold a visa or permit for temporary or permanent residence in the country of your destination? (Proof must be submitted)
Bn c th thc hoc giy php c tr tm thi quc gia s n khng ( ngh cung cp giy t chng minh)
.
Khng
I SOLEMNLY DECLARE THAT THE ABOVE PARTICULARS PROVIDED BY ME ARE TRUE IN SUBSTANCE AND IN FACT AND THAT I FULLY
UNDERSTAND THE MEANING THEREOF. I FURTHER DECLARE THAT I DO NOT CONTEMPLATE CHANGING THE PURPOSE OF MY VISIT
WHILST IN THE REPUBLIC.
TI xin cam oan rng tt c cc thng tin tI khai trn y l ng s thc v tI hon ton hiu ngha ca nhng
thng tin . TI cng xin cam oan thm rng tI s khng thay i mc ch chuyn I ca tI trong thi gian nam
phi
................
Signature of applicant
Date
Ngy
Loi th thc
L do
...............
....................
...............
..........
on ....................................
..........
Ngy
..........